When the school year opens this fall, more than 50 million children will, if the White House has its way, enter into more than just the schoolhouse. They will go into one of the largest unregulated experiments ever conducted.
In the wake of COVID-19, are they safe in going to school?
While many parents appreciate the need for schools to open, many are understandably concerned about this question. Schools not only educate, they also foster social development. And for many children, distance learning was hardly a success in the spring, which is why parents worry about their children’s safety in school. The problem is that we just don’t know: Epidemiologists and other health professionals lack the data to conclusively answer that question.
So what we face is an experiment with our children.
In medicine, scientists conduct experiments in the face of uncertainty. These trials aim to answer questions like: Will this new cancer drug cure someone? Scientists conduct experiments, discuss with patients the known risks of using the new drug and answer questions using available data. This is the morally necessary process of getting informed consent to participate in a study.
Lacking data on the risks of sending children back to the classroom, we essentially will conduct a giant, unregulated experiment. Yet no informed consent has been provided by those children or their parents. The mechanisms our society has developed to ensure that any experiment involving humans is ethically conducted, such as reviewing the plans to be implemented to assure adequate protection of children — especially those with special needs — have just been tossed aside by the Trump administration in its haste to open schools.
To date, though, no committees have been established to provide external review of what happens to children as schools open. External review by health care and public health professionals along with parents is crucial. There have been inadequate pilot demonstrations of how infection risks for school children will be minimized. There is no agreement on what will be done if there’s an outbreak of infections. More testing and tracing capacity will surely be needed to minimize the risks of opening. Will it be available in time? If additional teachers, janitors, and bus drivers are needed, we must secure funding for them now.
An oft-made argument holds that COVID-19 infections in children are “benign” and that students don’t infect teachers (or vice versa). But we don’t really know that because the available data are simply too sparse to be informative.
Consider that the virus is neurotoxic. Recovered patients have reported impaired cognition, delirium, fatigue, and memory lapses. A parent might rightly be concerned about the effect of infection on neurobehavioral development. We need to start collecting the data needed to see whether development is affected now — not sometime in the future. The same applies to the Multisystem Inflammatory Syndrome in Children already identified in a small number of infected children. We don’t know how common it is or why some kids are impacted when most appear not to be.
Recognizing that opening schools this fall is an experiment that needs to be treated as such, we have much work to do if we are to follow the processes developed to assure safe and ethical experiments. Safety is paramount if and when the school doors open. Isn’t that the least we should do for our children?
Arthur L. Caplan is the director of the Division of Medical Ethics at the NYU Grossman School of Medicine, and David E. Lilienfeld is physician and principal epidemiologist at Write for the Pharm, a consultancy focused on the development of pharmaceuticals.
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