Closing Schools Saved Lives During the Spanish Flu. Can It Work for Coronavirus?
As education and public health officials in the United States debate the pros and cons of shutting down schools to slow the spread of novel coronavirus, the Italian government on Wednesday joined the governments of Japan and Hong Kong in closing schools in response to the spread of COVID-19.
Widespread school closures seem an unlikely scenario in the United States at this point, especially when decisions are left to local authorities and any moves to shutter schools for a prolonged period would bring some steep costs to communities.
But what can research on previous pandemics tell school leaders and health authorities about what to do when weighing the costs and benefits of closing schools?
A report on the local government response to the 1918 Spanish Flu holds valuable lessons, researchers at the University of Michigan Medical School’s Center for the History of Medicine say.
Closing American schools earlier and for a longer period of time blunted the impact of the Spanish Flu in 1918, said J. Alexander Navarro, a co-author of the 2007 study and assistant director of the center. In that global pandemic, at least 50 million people died worldwide, including 675,000 in the United States, according to the Centers for Disease Control and Prevention.
Navarro and other scholars studied how 43 cities across the country responded to the Spanish Flu from 1918 to 1919. They found that cities that early on enacted “non-pharmaceutical interventions,” or NPIs, like school closures or bans on public gatherings, had a lower peak mortality and lower overall morbidity than cities that waited longer to do so.
Most cities “layered” different interventions. For instance, the first line of defense was often self-isolation for infected people or a quarantine. School closure, Navarro said, usually only becomes necessary after it is impossible to track how each individual victim was infected. In total, 40 of the 43 cities closed schools at some point during the outbreak.
School closures are “one of the more useful” NPIs a city can enact, he said. One reason is that people are already accustomed to schools periodically closing. “People are used to having schools close for snow days for a couple of days,” he said. “Longer school closures can be problematic, but if you went immediately to public gathering bans...I think that would be too socially dislocating.”
In China, where COVID-19 was first detected, the government has enforced strict “social-distancing” policies such as shuttering schools, closing down businesses, and ordering residents to stay in their homes. Those measures, while drastic, are helping to drive down the numbers of new cases in China, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told the Los Angeles Times on Wednesday.
The ‘Delicate Balancing Act’ of Closing Schools
But deciding to close schools is a “delicate balancing act,” Navarro said, more so now than it was 100 years ago when, for example, it was much less common for mothers to work outside the home.
“A huge number of students across the nation receive free or reduced-price lunches at school and so this is a major source of nutrition, as well as day care essentially," he said.
“If you take that away, how do you get meals to these kids?” Navarro added. “How do you give them a place where it’s safe and secure to be when public gatherings may not be safe from a public health standpoint?”
Prolonged closures would be a major disruptor to children’s learning, even in districts that may be equipped to deploy e-learning or remote-learning programs.
Schools ideally could even close proactively—that is, before a case is even reported among the student body, according to Nicholas Christakis, a professor of sociology at Yale University.
“Reactive school closure, while rational & helpful, is not enough,” Christakis wrote on Twitter. “In my view, schools should be closed *before* first case in a school, when cases appear in the community or in nearby areas. This is not without costs. But waiting reduces the benefits of #schoolclosure.”
Navarro agreed, but noted that closing a school proactively is a “difficult thing to do.”
“It’s hard to tell a community that doesn’t see cases or very few cases circulating in the wider community, perhaps none in schools, to say ‘yeah, we need you to close, and we’re going to close down all these schools for a lengthy period of time,’ Navarro said. “It’s very disruptive to parents and children.”
Navarro noted some caveats to applying the lessons of 1918 directly to the present, including changes in American civic culture. Declining trust in the government and a partisan political process could contribute to people questioning the judgment of public health officials.
Historical context also played a role, according to Navarro.
“One of the things it’s important to remember when talking about 1918 is that the United States was in the midst of the Great War, World War I, and so there was a tremendous sense of hyper-patriotism,” Navarro said. “There was this sense of, ‘do everything you can for the war effort.’ And when the influenza pandemic struck, that kind of morphed into the pandemic effort as well.”
Moreover, there are now legal concerns over who has the authority to close schools. James G. Hodge, Jr., a professor at Arizona State University, said that “the legal authority at the state level to close schools is ambiguous.”
“I can’t emphasize enough that closing schools is not like turning a light switch on or off,” Hodge said in an earlier interview with Education Week.
Still, Navarro stressed that in the wake of other diseases like the H1N1 flu in 2009, many school officials have given greater consideration to how to go about a widespread school closure.
“It’s been done before,” Navarro said. “It’s more problematic if it’s done on a wide scale for a longer time, but this is something that officials have definitely been thinking about.”