BALTIMORE _ Every parent knows a child with a cold is a leaky, disgusting mess. Snot everywhere. Coughs spread far and wide.
Diseases can travel fast when those kids show up at a day care center or school and begin spreading their germs _ or coronavirus _ onto desks, doorknobs and cafeteria tables. And the first instinct of state officials might be to slow the spread of the disease by closing these germ spreading factories _ quickly.
Experts say, however, that closing schools for long periods may not always be in the best interest of students or the public health. Districts in Washington, Oregon and New York have closed schools because of the virus, including about a dozen schools in the Seattle area closed this week, providing a preview of what may face other areas of the country. So far, those closures have been brief.
"We may think as soon as we hear about cases we should close school, but we should take a thoughtful and nuanced approach," said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security and an associate professor in the Hopkins' Department of Environmental Health and Engineering and the Department of Epidemiology. If schools are closed and parents can't find child care, they are stuck home with their children.
"We should make sure health care workers can get to work, people who stock groceries for us and others can keep society functioning," she said.
Closing schools for an extended period of time, such as a month or two, could have significant financial consequences for families and economic consequences for businesses and the state. For families who depend on day care facilities to take care of their children so they can go to work, staying at home during a closure might not be an option.
"You might have to go to work because that is the only way you can feed your family," said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security in the Bloomberg School of Public Health.
One of the central questions should be whether it turns out that students are those that are driving the course of the disease.
"It is unclear right now. It seems like kids don't get severe disease," said Sell. "Is it possible the less sick you are the less viral load you have? Those are questions we have not answered and those answers would help us decide what the best course is."
Some experts have argued that keeping schools open could mean that the disease will move more quickly and end sooner. But others say that it depends on the circumstances.
"I think it might be worth closing schools if it was clear that it lowered the epidemiological curve, so that fewer people are seriously ill at the same time," said Sell. "In that case, it could make it more likely that ICU beds and ventilators were available for the very ill and reduce chances that hospitals would be overwhelmed."
Another issue is leaving students who depend on school breakfasts and lunches without a source of food. While districts feed children in the summer when schools are closed students have to travel to centralized cafeterias. If students are still going to crowd together eating every day, "Are we changing the situation that much?" said Sell.
In addition, experts say that older, out-of-school children would still find places to congregate.
"It is unclear right now. It seems like kids don't get severe disease. Is it possible the less sick you are the less viral load you have? Those are questions we have not answered and those answers would help us decide what the best course is."
Tara Kirk Sell, a scholar at the Johns Hopkins University Bloomberg School of Public Health
"It's kind of a mixed bag," said Trudy Henson, Public Health Program Director at the Center for Health and Homeland Security at the University of Maryland Carey School of Law. "Closing schools can be effective if they are disinfecting the schools and preventing spread at school. But it's unlikely students are going home and staying home and not congregating somewhere else. They're at the malls or movie theaters, so you're just changing the place of transmission."
Students might fall behind academically if they are out of school for long periods of time. Educators say even a long snow break can be detrimental.
Maryland State Department of Education officials did not respond to questions about what protocols would be used for closing schools. Then-Maryland Gov. Martin O'Malley briefly closed several schools during the 2009 H1N1 swine flu outbreak at the advice of the federal Centers for Disease Control and Prevention.
In 2012 researchers at the University of Pittsburgh looked at data from the 2009 H1N1 disease and its transmission. Using statistical models they tried to calculate how long schools should be closed in the case of a pandemic.
"What we found was the optimal timing is eight weeks from a disease transmission" standpoint, said Tina Batra Hershey, an assistant professor in University of Pittsburgh graduate school of public health. Opening schools too soon might leave students vulnerable to infection. The same model might not follow for this outbreak, she said, and it should probably be left to local school systems to decide.
There are also legal questions. Many governors in the U.S. cannot simply order all the schools to close in their states. Across the country, state laws vary, said James G. Hodge, Jr., director of the Center for Public Health and Law at Arizona State University. "This is not about turning the light switch on and off."
If Maryland Gov. Larry Hogan were to decide he wanted to close schools, he has said he would make the decision collaboratively with the Maryland State Superintendent of Schools and Secretary of the Department of Health and Human Services. If Hogan declared a state of emergency, he could order schools shut.
Hodge said President Donald Trump does not have the authority to unilaterally close all schools in a state or across the country. The federal government doesn't own or run the schools, Hodge said, although they provide a small percentage of funding. "They could say either close your schools or we are pulling your funds. That would not be well received by states. The economic impacts of this are so profound. Some states might really be saying to the feds, we are not closing schools."
The decision about whether to close area universities and colleges would likely be far easier because students can more easily use online learning tools.
"It is a different set of challenges," said Joann Boughman, Senior Vice Chancellor for Academic and Student Affairs at the University System of Maryland. She said they have many options to provide alternative forms of study.
"Those of us who have levers to push will do so with as much sobriety as we can, but it is a quickly evolving situation," Boughman said.
