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Q&A: Malia Jones on in-person school decisions as vaccine arrives, pandemic continues
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Q&A: Malia Jones on in-person school decisions as vaccine arrives, pandemic continues

Malia Jones 121720 04-12172020202623 (copy)

University of Wisconsin-Madison epidemiologist Malia Jones reflects on 2020 and the COVID-19 vaccines in her home office in Madison.

Before 2020 closes out, the Cap Times got one more chance to check in with Malia Jones.

The University of Wisconsin-Madison epidemiologist has spoken with us multiple times this year to share her insights on the pandemic. In the summer, we talked about schools as they considered how to begin the 2020-21 school year.

Now, nearly through the first semester, the Madison Metropolitan School District is again approaching a decision on whether to remain virtual or return some students for in-person learning in late January. Jones reached out to the Cap Times about the upcoming decision, and suggested we talk again about schools.

The full interview transcript is below, edited for clarity. You can also listen to it in podcast form on the Madsplainers feed.

I'll start with one of the same questions we asked you last time when we talked over the summer: How are you doing as a parent through all of this uncertainty with school?

Yeah. Last time you asked me that question, I opened our whole interview with what is now famous among my friends as the "three second sigh." And I have to say I'm actually in a much better place now. Because I feel like some of the uncertainty, at least for us, has been resolved. And with the vaccines having been approved so quickly and now other relatively good news coming on the COVID front, I'm feeling a lot more hopeful about the future. So we're doing pretty well.

I'm really glad to hear that. How has virtual learning gone for your two kids?

I have a first grader and a fifth grader, as I think we talked about last time and virtual learning for my fifth grader was going extremely poorly. And we made a decision in November to pull him out of public school. And he is now homeschooled. Which, you know, a lot of people have said, when I said that, "Oh, my gosh, how is that working for you while you're working full time?" And I have to say it's actually been less work, because we don't have to sit with him constantly and keep him on task. Virtual school was really deeply challenging. And it's going somewhat better for my first grader. But that's because he has his grandma available to him as essentially a full time learning coach. And so he really does have a lot of hands-on support to help him do it.

Well, good for you all for making the decision you needed to for your kids.

Yeah, it was a difficult decision to make on several different fronts. And one of them was certainly that I really do feel strongly that I want to support my public school system and the state public school system but it just wasn't working for him at all, wasn't working for any of us.

What do you think about MMSD's consideration of returning for in-person school for at least its youngest students right now?

Yeah. Well, I think it's clear that the evidence for what's happening in education, especially for the youngest students, is that virtual learning is next to impossible to do with any kind of quality in spite of the teacher's best efforts. And I think a lot of kids are struggling and I know a lot of teachers are struggling with it. And so I certainly understand the educational and developmental and social reasons to want to return to in-school. Of course, we're thinking about doing this while the pandemic is still afoot. And so there's another set of considerations about returning to in-person instruction on the COVID front. And those are pretty complex, but I guess the short version of that is that I do have some concerns and also I have some hopes and fears around what that's going to look like. 

Would you like to expand on that?

Yeah. One of the pieces of really good news is that the two vaccines have received emergency use authorization from the FDA and they've been rolled out. Health care providers are already getting them, some people in long-term care facilities are already getting them. The data on the efficacy in these vaccines looks great. And the CDC recently recommended that teachers be in the very next priority group for receiving vaccines. And, you know, depending on how the logistics of rollout of the vaccine is going, we could expect teachers to be starting to get the vaccine and the other people who are in the second group, Group 1B, to start getting the vaccine within the next few weeks. And so I really am hopeful that we can get teachers at least vaccinated and protected from exposure to COVID in their classrooms before we get back to in-person instruction. There have been some real challenges with vaccine rollout in some places. I hear it's going pretty well in Madison. And I hope that continues and that we can see a rollout to this next group, which includes people who are 75 years and older, as well as what they called frontline essential workers. And that does include teachers. I hope that goes smoothly and happens quickly.

Absolutely. You mentioned some of the fears about the possibility of the district returning to in-person right now. What are some of the concerns that you have?

My concerns are that I really haven't heard anything about what the mitigation strategies are going to look like in terms of what will these classrooms look like. Will it be the regular density of kids? I imagine that they'll be asked to wear masks, because that's been pretty universal. But you know, masks are not a magic forcefield, perhaps especially on a kindergartener, and they have to be removed for eating lunch and, you know, they're often removed for mask breaks, some school settings are doing something like that. So I want to see kids wearing masks, as well as, if possible, having some lower density within the classrooms. And that would mean doing some pretty substantial rearrangements to the classes themselves. And I just haven't heard anything about how that might go.

I have seen some internal communications that have sort of indicated it'll probably be classrooms limited to 12 to 15 students apiece. Now the logistics of that, as you mentioned, that's well below a normal class size. So the logistics of what that means and how that actually plays out and who's still virtual or who's teaching kids who opt for virtual, that has not really been made public in detail yet.

I understand a huge logistical challenge. One of my concerns with it is actually that, you know, I really do hope that they figure out a way to spread kids out so there are less kids in one room together. But I've also observed that it's very hard for kids and families to deal with all of this change and uncertainty. Kids really thrive on stability. And these changes are hard for them. And so if they want to reduce the classroom sizes down to 12 or 15 kids, a lot of kids will get a different teacher most of the way through the year, which I think is a challenge.

And that actually leads to my other fear about what this could look like is that the schools, MMSD, are not operating in a vacuum. We live in Madison, and what we saw happen in the fall was that UW Madison brought several thousand undergraduate students back for in-person higher education and that led directly to a pretty big spike in cases first on campus and then slowly diffusing out into the community. We've mostly recovered from that big spike at this point. But I'm really worried that the timing of this reopening is going to be right after the kids come back again to college and that we could see another huge spike related to the undergraduate students returning from all over the country where there is really high disease load, and then moving back into those really high density places where undergraduate students tend to live, shared apartments and fraternity houses and dormitories. And so the whole context of college returning around the same time, it worries me that MMSD is going to make a set of difficult logistical decisions, and then we'll have to react to a big spike in cases in the community.

Having seen that sort of spike when college students initially return in the fall, when K-12 was still virtual, mixed with some of the data that has come from places that are in person for K-12, how does that change your thinking from an epidemiology perspective as far as what we should be thinking about and looking at?

This is still a matter of considerable debate in the epidemiology community, is this question of how much COVID transmission happens in classrooms in K-12? And I will say that, in the United States, although there are many schools that are operating as if everything was completely normal, we do not have any kind of representative sample of transmission in those schools to draw on that would really tell us whether and how much COVID transmission was occurring within school settings. When we look at the, I mean you might call it kind of circumstantial evidence that we have, it does look like the K-12 school setting is not the leader in super spreader events. We don't see a whole classroom coming down with COVID at the same time. But we do see some associations between how much COVID is happening in the community and how much COVID is happening in schools. And it's very hard to tease apart the direction of that influence. And you know, how much being in-person school really is leading to COVID cases going up in the community. I would say that certainly, in places where there is a lot of COVID circulating in the community, that means there's a lot of COVID in the schools too. And so the students there, and the teachers there are more likely to be exposed to COVID. Because, you know, some of those people are bringing COVID into the school with them just as a function of that's just the math, that's if there are 100 people with COVID and 10 of them go to school, then you've got 10 cases of COVID in your school. 

We do know, though, it looks like kids are not as good at spreading COVID as adults are, and maybe particularly younger kids. That's not to say they can't. And there is some very compelling evidence from Europe that suggests that they do, and in fact, they have more asymptomatic infection than any other group, but they don't transmit as efficiently. And so that's probably why we don't see the super spreader events in classrooms where a whole classroom gets sick all at one time.

What sort of data or research are you looking for to inform your thoughts about how schools and if schools should reopen? What kind of information should people be paying attention to?

Well, I think the first thing that we should be asking is what do we know about how well COVID is transmitted in classroom settings, and then try to try to look around and say, well, how much COVID is in the community? How likely is it that any kid is going to be bringing COVID into the school or adult who works in the school? And then we can start to think about questions of, okay, so we know how much COVID is circulating in the community, how well do kids transmit it? Do they bring it home? Do you get a COVID infection in school and then bring it home to your parents or your grandparents? What can we do to reduce those risks by doing things like wearing masks, and then reducing the density of kids in the classroom, improving ventilation? All these, I would call them lower level mitigation strategies, have to come after questions about how much COVID is present in this community more broadly.

What would you say of Madison's trends right now with COVID? Is it good, bad, close?

Madison's been doing pretty well, the rates are trending down. And I think that's really promising. I don't know that anything is really different from August, right before the university students came back. Rates at that time were also fairly low. And when the university brought students back, they shot up really quickly. That could absolutely happen again, in fact, I would expect it to. Because they're trending down right now, that's good, obviously, that's very good. And especially in a context where now some people are being vaccinated, we can protect those of us who have the most exposure, and the highest risk of poor outcomes. I hope this is the beginning of the end. I hope that big spike that we saw in November was it. But also, that kind of depends on a few things. And one of them is what happens when the university students come back? And one of them is how efficiently the vaccine can be rolled out to more groups, including teachers? And then, of course, what can be done to reduce transmission in schools?

On a recent Dear Pandemic discussion about schools, you mentioned something like with schools, it's become a policy decision rather than a science decision. Can you explain what you meant by that?

Yes. The question of whether things are going to reopen or not, really, you can ask epidemiologists to inform on those decisions, but they are ultimately not made by scientists, they are ultimately made by policy people. And I may have said that with a little bit of irritation in my voice, because I don't feel like policymakers are really listening to science at this point on the issue. And I think even some scientists are not doing very rigorous science around just how likely is school transmission? And how much is that contributing to community spread? And that's because it's a matter of priorities. There are a lot of competing priorities here. And one of them is getting kids back in school. I mean, it's important. I completely agree with that point of view.

One of the challenges I've noticed as a reporter in trying to sort out how things are going in places is much of the data that is out there for the United States, especially, seemingly is voluntarily reported. Is there a way to fix that problem? What would be the way to go about getting better data?

Well, what we have seen in some other contexts is a representative sample, random sampling strategy that samples children for COVID infection. Or in some cases, and we've even seen this in a couple of local places in the United States, where we sample a whole population for antibodies to COVID, to find out what the past prevalence of COVID has been in the population. And the advantage there is that we would catch many more symptomatic and asymptomatic infections. One of the challenges with volunteer data, aside from the who ends up volunteering their data sort of social challenges, is that if kids are more likely to be asymptomatic, but have COVID and in some cases pass it on to other people, and we're only mostly testing people who have symptoms, especially when it comes to a school setting, then we're missing a ton of infections in kids. And so your sample is going to look like, almost by necessity, it's going to look like kids have very few infections and transmit COVID in the school setting very rarely. But it could be that we're just not testing kids at random in a way that would tell us whether they're getting infected. There was a study in Austria and another one in Iceland that both did a random sample of kids. And essentially, this looks like kids are randomly enrolled in a study, and then they get tested to see if they have COVID once or more than once, we see that kids actually do have a lot of asymptomatic COVID. And the outcomes of those two studies in particular vary a little bit. The Iceland study suggested that kids spread COVID considerably less than adults do but still do spread it. And the study in Austria suggested that kids may actually be driving the continued increase in cases in some areas.

Another thing that's going on right now is some of the surrounding communities are starting to open back up a little bit more with schools, some already have some younger grades in person. Both Verona and Middleton Cross Plains recently voted to phase-in more students being in person. Is it good or bad from an epidemiology perspective to have multiple communities approaching a phase-in like that? And if Madison chooses to, obviously Madison would be added to that list. Is that going to make it harder to tell where potential spread is coming from?

So it turns out that it's really hard to tell where potential spread is coming from in any case. It's just a hard thing to track down. If it were a really rare infection, then we could call up the three people who had it and ask them everyone they had been in contact with over the last two weeks and figure it out, we could figure out the exact transmission chains. But the pandemic is so widespread at this point that there's just no telling. There's no disentangling if cases from Verona are bleeding over into Madison, or like, who knows. That's not going to be possible. So we don't have any shot at getting that kind of information.

I think that, given that that ship has sailed, it's probably good that it's a phased reopening, because we can kind of test out what's working, test the waters a little bit, back off if it's not working right, experiment with different strategies without just having everybody dive into the water at the same time.

The other thing I'll say is that one of the real concerns about schools reopening is it leads all of us to start thinking about the pandemic in a different kind of way. It leads to other things reopening. If schools are open, well, what about afterschool sports? And music lessons and swim lessons? And, well, maybe I can go to the gym after I drop my kids off at school. It's kind of a mental signal, some behavioral scientists think, that everything's fine, and that we can stop restricting our interactions on other fronts as well. And that might actually be what leads to concurrent cases in the community, cases in the schools being pretty much parallel.

So one of the recommendations that I have and other scientists have is that if schools do reopen, families who are sending their kids to school in person really need to think of that as as their whole interaction budget. And they need to not be doing anything else. Because even if it's not happening in the schools, if you're sending your kids to school, and that means you're also doing a bunch of other stuff, the bunch of other stuff could lead to a big spike in COVID cases.

That sort of goes along with some of the messaging I've heard on schools from people pushing to reopen, saying prioritize them, but really prioritize them. That doesn't mean just open them to open them. You need to, as Dr. Fauci said, if it's a choice between the bars and the schools, open the schools.

Yes. Yes, it is. And we saw that really clearly in the fall. You can't have everything open and expect to have cases remain flat, right? In fact, you can't even have some of the stuff open and expect cases to remain flat. If we want schools to be open, I think we need to seriously consider shutting down other things that are currently open.

Anything specific that concerns you in Madison, as far as that goes?

The authorities in Madison and Dane County have been pretty responsive to what's happening in terms of local case counts. And so the guidance changes a lot. And so I'll say more generally that when we look at the whole body of evidence of where people tend to get sick, it's very often in workplaces. Indoor dining is a huge problem. Bars are clearly a huge problem. Gyms, not a good idea. You know, any place where there's a lot of people together, mixing in settings where they don't normally spend big chunks of their day, and especially if they're there for a while and eating, singing, dancing, breathing hard, shouting, those are the highest risk businesses. We also know, looking at the evidence so far, that we have a real tendency to let down our guard around people we know. And so people are getting sick at small gatherings, often with people they know. So I would say there's also some personal responsibility to restrict some of those small game nights or having a few friends over for beers or whatever it is. So not just businesses, but also private gatherings.

Absolutely. So to get back to Madison schools, specifically, they have said that even if they do open for in-person instruction for some students, they'll still offer a virtual option for families that choose to go that route. With that in mind, would you send your children to in-person school right now?

I would not send my children to in-person school right now. I can give you a couple reasons for that. I want to start off by saying that this question is going to be about striking a balance for each family, so it is a personal trade off. People have to trade off what the pros and cons and what their needs are for them. For me and my family, on balance, I said at the top that we’re doing OK, we’ve kind of found a rhythm. It’s definitely not ideal, it’s going to be the weirdest year of my kids’ education ever, but it’s going. We’ve got something that’s mostly working for us right now. I don’t think I want to disrupt that. The reasons I don’t want to are, first of all, there’s sort of the society-level reason. I’m a population scientist, I think a lot about how my actions interact with the actions of the other people in my community. I have some real concerns about equity and school reopening. The thing about COVID in schools is that even if COVID in classrooms isn’t the top of the list for superspreader events — like I said, we’re not seeing a whole classroom of people all get sick at once — we do see some kids who get COVID in school settings and then take it home. When that happens, you don’t need it to be every kid in a classroom to have it turn into a problem at the community level. It’s particularly a problem for certain kids who live with older people or parents who have high-risk conditions or parents who are essential workers or parents who don’t get sick leave. I think there are some real equity concerns and since we’re OK at home right now, we’re in a position of relative privilege and it’s working, we can stay home, I don’t feel good about contributing to that potential problem at the community level.

Especially with the vaccine just within reach, I feel like, oh man, if we could just give this even a few more weeks, we would probably be in a better place and we might not ever realize those problems. If you were to ask me this question again, if this were four months after a vaccine rollout instead of two weeks after, I might have a different point of view.

The other reasons are more personal. I’ve seen among my friends and my colleagues, other districts that have reopened, and they have often had to close again after cases have gone up in the community either for some other reason or maybe schools have contributed to this mentality of everybody reopening the rest of their lives and getting back to normal. I find that really disruptive. After a year of all this uncertainty and mix up with my kids and their education, I need to be able to rely on what the plan is. Right now we have a plan that I know is stable and we’re just going to stick with it for the rest of the year.

The last reason is that personally I just don’t want to get COVID. People like me, I’m not an essential employee, I can work from home and I have been working from home for almost 10 months now. I can probably expect to wait until April, May, maybe June before I get a vaccine. I’ve invested 10 months in keeping myself safe and not being one of the cases of COVID in my community and I’m not willing to just abandon that and put my family at risk. The other thing is that kids are not going to get a vaccine for even longer, kids trials are just getting started so a kids vaccine is quite a ways off. The only other people in our bubble are my in-laws, they’re older, they’re high-risk. They will get a vaccine as soon as it becomes available to them, but we’d have to stop seeing them, we’d have to cut them out of our bubble if we were to start sending our kids back to school. We’ve really relied on them for a lot of support and child care over these last many months and that’s just not something I would be willing to give up in order to send my kids back to in-person school for the next few months here.

All of that said, that all works for us because of the position that we’re in. We’re able to make it work at home. I would not judge another family for coming down on the other side of this decision. There are people who aren’t OK at home right now. There are people who their kids have no child care, they have no income because they can’t send their kids to school. There are going to be families who do want to send their kids back to school no matter what, and I would not pass judgement on them for coming down on the other side.

With that in mind, and despite the earlier discussion about a policy decision versus a science decision, from a science perspective, from your perspective, is it a good idea for Madison to open up schools right now for in-person instruction?

So one of the reasons that I've, like kind of balked on answering this question is because I'm an infectious disease expert. No, from an infectious disease perspective, that's not a good idea. You know, it's kind of obvious, but there's not another person on this podcast who can speak to the other point of view, which is, if we had an early education expert, she would be saying a very different thing. And so I'll kind of just allude to that point of view, even though my point of view is almost entirely infectious disease. There is another legitimate point of view here, and there are competing interests. They compete with one another, I don't think you can have both. So it's really sticky. It would be helpful if we had some very clear evidence about how do you exactly reduce the risk of transmission in school settings? But we don't. The whole thing is really a frustrating mess.

It still stuns me when I realize we're only really a year into having any data to even collect on anything related to COVID. So of course, there's still a lot of mystery out there.

There is so a lot of mystery out there. I almost feel like we're going to a tortoise versus hare race right now that the the vaccine, it's right there, it's within our reach, and if we can get those people who are going to be the most exposed in the school settings vaccinated, many of my fears would be relieved at that point. To see teachers protected and to see the older people that that school-aged children live with protected, that would be just like a slam dunk on the science. I would go around high fiving every scientist in town.

After you'd all been vaccinated, right?

Virtually high-fiving.

Is there anything else related to Madison's considerations right now related to schools that you'd like to mention that we haven't gotten to yet?

So the CDC is saying that the the timeline for getting phase 1B started is within a few weeks. But there have been some failures and some delivery snafus and other issues with even the first phase rolling out around the country. And so I don't have a ton of confidence as to exactly when phase 1B is going to start. The other thing about it is that those CDC recommendations are just recommendations. They're not requirements. And so every state actually gets to make its own decisions about who goes first. I very much hope that teachers remain on that list in accordance with the recommendations. And also I do think that having the 75 and up age group in the very next priority group is a very good idea because those are the people who are at most risk of hospitalization and death. And so I hope the state goes with the CDC recommendations and that it all goes really smoothly and then we could be looking at in Madison having most teachers and a substantial number of older people vaccinated around when schools are going back. That would be great. Let's aim for that. Make it happen, Scott.

I will do my best. That sounds like a really good plan.

Yeah, it would be a really good plan. This would alleviate many of my fears.

I love having hope on the horizon. That's a very, very nice place to be and I think a good place to end our interview. Thank you so much for being here again with us. You shed light on a lot of important points, and we really appreciate it.

This school one, I always feel like this is where the waters are the most muddy. And so I don't know how much light there really is to shed on it, but maybe at least I have enlightened everyone as to how tricky and impossible this whole thing really is.

 

Share your opinion on this topic by sending a letter to the editor to tctvoice@madison.com. Include your full name, hometown and phone number. Your name and town will be published. The phone number is for verification purposes only. Please keep your letter to 250 words or less.

Scott Girard is the local k-12 education reporter at the Cap Times. A Madison native, he joined the paper in 2019 after working for six years for Unified Newspaper Group. Follow him on Twitter @sgirard9.

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