Many teachers and families feared a spike in COVID-19 cases when Florida made the controversial push to reopen schools in August with in-person instruction.
A USA TODAY analysis shows the state’s positive case count among kids ages 5 to 17 declined through late September after a peak in July. Among the counties seeing surges in overall cases, it’s college-age adults – not schoolchildren – driving the trend, the analysis found.
The early results in Florida show the success of rigorous mask wearing, social distancing, isolating contacts and quick contact tracing when necessary, health experts said.
“Many of the schools that have been able to successfully open have also been implementing control measures that are an important part of managing spread in these schools,” said Dr. Nathaniel Beers, who serves on the American Academy of Pediatrics' Council on School Health.
Although things went well early, the experts cautioned that schools could still be the source of future problems. They warned against reading the data as a reason to reopen all schools or abandon safety measures.
Hundreds of students and staffers contracted the novel coronavirus despite the precautionary measures. The Florida Department of Health published a report last month showing 559 COVID-19 cases related to elementary, middle and high schools logged from Aug. 10 to 23. State health officials quickly retracted the report, saying it was a draft and “inadvertently made available.”
Despite the bright spots in the data showing school-age cases declining from their summertime peak, there was one troubling trend: The rate of decline slowed in many places after schools reopened.
That might mean cases have plateaued and schools have not fueled new, large outbreaks. Or it might mean those counties are at the bottom of a U and could soon turn upward again.
“It’s one of those things where it’s not a problem until there is a problem,” said Dr. Katherine Auger, an associate professor of pediatrics at the University of Cincinnati College of Medicine who studied the lives saved by spring school closures.
All eyes on Florida
Health researchers and educational experts watch Florida for cues about what works to keep students, staff and the broader community safe amid a pandemic.
Most of the largest school districts around the country – including those in New York City, Los Angeles, Chicago and Las Vegas – reopened with virtual learning plans. Florida mandated that public schools offer face-to-face instruction and that campuses reopen no later than Aug. 31, a decision that drew an unsuccessful lawsuit from the state teachers union.
More than half of Florida families returned their children to school in-person, state education officials said. The rest chose remote learning.
As weeks ticked by and a surge of school-linked cases did not materialize, requests to return remote learners to the classroom have surged in some places.
In Martin County, along the Atlantic Coast, the school district logged more than 160 such requests. That’s nearly four times as many as those asking to switch from in-person to remote.
Caitlynne Palmieri was among the Martin County parents wanting to return her child to the classroom.
She initially enrolled her 9-year-old in the remote learning option because of high community infection rates. Her son, a fourth grader, had trouble focusing on schoolwork from home. When she saw how safety measures were implemented and adhered to, Palmieri sent him back to the classroom.
“I knew it was right for us,” she said. “He wanted to be back, and I felt safe.”
Schools in Martin County reopened Aug. 11. In the four weeks prior, the state Health Department reported 69 coronavirus cases among school-age children. In the four weeks after opening, the data shows 62 cases in that age group.
In Florida, unlike most states, there is one school district for each county, making it easier to analyze the impact of reopening schools on county coronavirus cases.
The Health Department in Martin County has seen little evidence of in-classroom transmission within the school district, spokesperson Renay Rouse said. Transmission is linked to students’ out-of-school or social activities.
COVID-19 cases “are leveling off, and the trends are going in the right direction, (and) the preventive measures adopted by the school district community have been an essential part in stopping the spread of the virus,” Rouse said.
Lesley Fidler, whose son attends kindergarten at Jensen Beach Elementary School – which has issued no quarantine orders – praised the school’s safety measures.
“My family was against sending him to in-person schooling, but (the district) has it seamlessly laid out,” Fidler said. “I’m super impressed with the teachers. Students are spaced out, everyone is wearing a mask (and) the principal and assistant principal have been very positive.”
The decision on whether to send kids back to school is a difficult one, said Jason Salemi, an epidemiologist and professor at the University of South Florida. He emphasized the importance of the mitigation efforts school districts put in place before reopening.
“Schools have worked so hard to put these measures in place,” Salemi said. “We need to stay vigilant. You can see the writing on the wall. Cases have spread pretty rapidly in college towns.”
A tale of two campuses
Though state data does not show dramatic increases in positive tests among kids, the rate of infection has grown among some adults, primarily 18- to 25-year-olds.
Two counties – Alachua, with the University of Florida, and Leon, with Florida State University and Florida A&M – set records for cases in September. The number of young adult cases are rising even in counties without large campuses, the USA TODAY analysis found.
Many factors probably influence the contrast between college- and school-age cases, experts said.
When children go to school, they’re often in one classroom and under close supervision for most of the day. When they return home, many families limit social interactions.
Young adults might attend college classes with strict coronavirus precautions for only a couple of hours each day. The rest of the time, people in that age group tend to socialize with a broad group of people and work service jobs where they interact with dozens of strangers in a single shift.
The differences between kids and young adults can be seen in the coronavirus data throughout Florida for the past couple months.
In Jacksonville, in the northeast corner of Florida, Duval County education stakeholders braced themselves when in-person school resumed Aug. 20. Elementary students attended daily, and middle and high schoolers were on a hybrid schedule that brought them to campus on alternating days. All grade levels had an option to take full-time virtual classes, although less than a third of students did.
Duval Schools Superintendent Diana Greene called the number of cases – 94 as of Friday – "manageable" for the district of about 111,000 students.
The number and rate of K-12-age cases in Duval County has remained consistently lower than those of college-age young adults since the start of fall semester. The community is home to several colleges, each of which tracks COVID-19 cases differently.
In the month before K-12 students returned to campus in Duval, 608 school-age children tested positive, and so did 974 young adults. In the month after school reopened, the state logged 312 cases among school-age children and 747 among young adults, according to the USA TODAY analysis.
More than half of COVID-19 cases reported by the school district are at elementary schools, where all instruction was in-person. The district expects to fully transition to daily in-person classes for secondary schools this week, and some stakeholders worry the case numbers will pick up.
"The dashboard is starting to show some higher case counts at certain schools and particularly among staff," said Jennifer Cowart, a physician and parent. "If staff are already being affected at these schools under hybrid, and we go full brick and mortar, what happens to students and staff then?"
Safety at the cost of learning
The USA TODAY analysis for Florida mirrored findings from a nationwide survey of hundreds of schools by Brown University in partnership with the American Association of School Superintendents and other organizations.
The first set of data released last week showed low infection rates at 351 schools offering in-person instruction either daily or as part of a hybrid model: 0.08% of students and 0.14% of staff had a confirmed coronavirus infection in the past two weeks.
For perspective, about 0.17% of all Floridians tested positive in the past two weeks, according to state figures. During the state’s July peak, the figure was 0.74%.
As more schools join the anonymous, voluntary data collection effort, Brown University experts said they hope to provide more insight about which mitigation measures are most effective.
In many places, the steps schools must take to ensure the health of students and staff can prove a significant disruption.
In Bradford County in north central Florida, 43 students and 40 teachers tested positive for COVID-19 since classrooms reopened the last week of August, Assistant Superintendent David Harris said. Those positive cases resulted in about 640 students being sent home to isolate.
“Very, very few – less than five – of the kids who were quarantined tested positive,” he said. “We're sending a lot of kids out of school for 14 days that don't need to be. That's our biggest issue. That's a huge problem. ...They're falling behind."
In some places, school leaders described a growing appetite, if not demand, from parents to roll back some of the safety policies because massive outbreaks have rarely been linked with school-based transmission and because so many students who are not ill have had to miss classes.
Last week, the school board in Miami-Dade County – one of Florida’s three districts granted an exemption to in-person learning because of high coronavirus case counts – voted to return to classrooms in mid-October. It has been instructing children virtually.
Other schools plan to roll back some safety precautions as cases drop.
“Our positivity rates are declining, and if we can maintain and hold lower positivity rates, it is very possible that we could revise recommendations,” Kristine Hollingsworth, a spokeswoman for the Health Department in Collier County in southwest Florida, wrote in an email.
When Collier’s reopening plan was announced, County Department of Health Director Stephanie Vick released guidelines that the district's safety measures, such as masks, may be incrementally phased out or reduced once positivity falls.
More than five dozen positive cases were reported in Collier schools since nearly two-thirds of the district’s 47,000 students returned to classes Aug. 31, according to the district’s COVID-19 dashboard.
Even considering those relatively low case numbers, some Collier school board members worry that the number of students isolated because of close contact with an infected person affects learning.
“I'm still hearing from people who want restrictions to roll backwards,” board member Stephanie Lucarelli said.
The county’s school board members haven't seen the numbers on students and staff who had to be quarantined. The district has not released that data to the public.
"To focus on quarantine numbers could lead to a series of inferences about COVID-19 positivity that may not be the case," Chad Oliver, Collier’s district spokesman, wrote in an email. “We are mindful that positive cases and positivity rates are analytically different from students who may have to be quarantined that are not COVID positive.”
Health researchers hope the emergence of more data will help them answer the questions school leaders and parents have about what to do.
“Do you really need to shut down the whole classroom? Or do you only need to isolate a couple children who sat next to the infected person?” asked Auger, the doctor and researcher from Ohio. “We don’t know yet. We need more research.”
The scene at Norrsken House Stockholm, a co-working space, oozed with radical normalcy: Young, turtleneck-wearing hipsters schmoozed in the coffee corner. Others chatted freely away, at times quite near each other, in cozy conference rooms. Face masks were nowhere to be seen.
It seemed very last January, before the spread of Covid-19 in Europe, but it was actually last week, as many European nations were tightening restrictions amid a surge of new coronavirus cases. In Sweden, new infections, if tipping upward slightly, still remained surprisingly low.
“I have potentially hundreds of tiny interactions when working here,” said Thom Feeney, a Briton who manages the co-working space. “Our work lives should not be reduced to just the screen in front of us,” he said. “Ultimately, we are social animals.”
Normalcy has never been more contentious than in Sweden. Almost alone in the Western world, the Swedes refused to impose a coronavirus lockdown last spring, as the country’s leading health officials argued that limited restrictions were sufficient and would better protect against economic collapse.
It was an approach that transformed Sweden into an unlikely ideological lightning rod. Many scientists blamed it for a spike in deaths, even as many libertarians critical of lockdowns portrayed Sweden as a model. During a recent Senate hearing in Washington, Dr. Anthony S. Fauci, the leading U.S. infectious disease specialist, and Senator Rand Paul, Republican of Kentucky, angrily clashed over Sweden.
For their part, the Swedes admit to making some mistakes, particularly in nursing homes, where the death toll was staggering. Indeed, comparative analyses show that Sweden’s death rate at the height of the pandemic in the spring far surpassed the rates in neighboring countries and was more protracted. (Others point out that Sweden’s overall death rate is comparable to that of the United States.)
Now, though, the question is whether the country’s current low caseload, compared with sharp increases elsewhere, shows that it has found a sustainable balance, something that all Western countries are seeking eight months into the pandemic — or whether the recent numbers are just a temporary aberration.
“It looks positive,” said Anders Tegnell, Sweden’s state epidemiologist, who gained global fame and notoriety for having kept Sweden out of lockdown in March.
With a population of 10.1 million, Sweden averaged just over 200 new cases a day for several weeks, though in recent days that number has jumped to about 380. The per capita rate is far lower than nearby Denmark or the Netherlands (if higher than the negligible rates in Norway and Finland). Sweden is also doing far better, for the moment, than Spain, with 10,000 cases a day, and France, with 12,000.
In response to the recent outbreaks, many European countries are imposing new restrictions. But political leaders, anxious to avoid unpopular and economically disastrous lockdowns, are relying mostly on social-distancing measures, while trying to preserve a degree of normalcy, with schools, shops, restaurants and even bars open.
In essence, some experts say, they are quietly adopting the Swedish approach.
“Today, all of the European countries are more or less following the Swedish model, combined with the testing, tracing and quarantine procedures the Germans have introduced, but none will admit it,” said Antoine Flahault, director of the Institute of Global Health, in Geneva. “Instead, they made a caricature out of the Swedish strategy. Almost everyone has called it inhumane and a failure.”
Back in the spring, when other nations were clamping down, Sweden was often vilified for having gone its own way. Its borders stayed open, as did bars, restaurants and schools. Hairdressers, yoga studios, gyms and even some cinemas remained open, as did public transportation and parks.
Gatherings of more than 50 people were banned, museums closed and sporting events canceled. But that was the extent of the measures, with officials saying they would trust in the good sense of Swedes to keep their distance and wash their hands.
Mr. Flahault lauded Sweden’s government for that part of its approach. “The Swedes went into self-lockdown,” he said. “They trusted in their people to self-apply social distancing measures without punishing them.”
But Mr. Flahault also warned about what he called a major flaw in the Swedish approach. “They continue not to wear masks,” he said. “That can be a big drawback in the Swedish strategy if masks prove effective and key in fighting the pandemic.”
Sweden might also just be enjoying a lull between peaks of infection. The public face of the country’s coronavirus policies, Mr. Tegnell, agrees, saying the numbers can always go up, as they just have. That said, however, “Sweden has gone from being one of the countries in Europe with the most spread to one that has some of the fewest cases in Europe,” he said in a recent interview.
Mr. Tegnell said that Sweden would in certain cases prescribe face masks, particularly to contain local outbreaks. And in a break from the past, he told the Dagens Nyheter newspaper that he would now even consider limited, local restrictions on movement and school closures.
But he still insists that distancing provided overall better protection than masks, which he says could give people a false sense of security.
Mr. Tegnell stressed, as he has many times before, that Sweden did not set out to achieve “herd immunity,” calling it a “myth that has been created.”
“We are happy that the number of cases is going down rapidly and we do believe immunity in the population has something to do with that,” he said in the interview, conducted just before the case numbers rose slightly. “And we hope that the immunity in the population will help us get thought this fall with cases at a low level.”
When the pandemic struck in the spring, the Norrsken House Stockholm, in a former tram depot, looked abandoned, as many of its 450 members stayed home. But by mid-August the place seemed normal. People mixed without visible worries or fears. Some minimal precautions were taken: Workstations designed for six were restricted to four; hand sanitizer stations were everywhere; and most people were social distancing.
“These limitations are going to be in place for a little while, I think, but it doesn’t feel like a big restriction on your day-to-day life,” said Mr. Feeney, the manager. “There’s a yearning for wanting to get back to normal. Finally people feel, ‘OK, we can do this again now. We’ve got through this.’”
The changes are just as noticeable in Sweden’s hospitals. At the Sodersjukhuset hospital in Stockholm in the spring, ambulances were constantly unloading Covid-19 patients. “In April it seemed as if almost everybody had Covid,” said Karin Hildebrand, a cardiologist in the intensive care unit. “Even those brought in for heart failure were positive as well.”
Now, Dr. Hildebrand was enjoying a cappuccino before her shift, casually greeting colleagues who seemed just as relaxed. “We don’t see any Covid positive patients anymore,” she said. “How many are there now on our ward?” she called out to her colleague. “One,” he replied. Dr. Hildebrand smiled.
She was disturbed during the first wave by how many of her friends were lax about social distancing and other precautions. In April, she went on national television, to warn Swedes that the situation was grave.
Now, however, Dr. Hildebrand says Sweden is well prepared for a potential resurgence. “We changed behavior. I don’t see anybody shaking hands, for example,” she said. Recently, she vacationed in the north of Sweden, rock climbing and hiking. “Life is back to normal. But of course there can be a second wave.”
Some experts believe Sweden is now almost fully in control of the virus.
“There are indications that the Swedes have gained an element of immunity to the disease, which, together with everything else they are doing to prevent the infection from spreading, is enough to keep the disease down,” Kim Sneppen, professor of biocomplexity at the Niels Bohr Institute in Copenhagen, said in an interview.
He stressed that the country could have avoided the high death toll in the beginning, but said that Sweden had regained control from mid-April, when deaths declined steadily.
While the Swedes are far from having achieved herd immunity, he said, “we can conclude that their social distancing rules have proven essential.”
