A Look at DESE's Cited Sources: Results of a Critical Look at the Initial Reopening Guidance References

Note: I've been doing a lot more work around education safety lately, but moved it away from this blog. I founded Massachusetts Education Safety Advocacy Group (MESAG) and you can find up-to-date research on the website, Twitter, and Facebook. Please follow, like, and share!

I read and analyzed all of the sources cited in the DESE document released 6/25. You can see my write-ups of all of the sources here.

Here's what I found:

The report has 84 citations of 53 unique sources:

• 8 of the 53 sources are public-facing CDC web pages
• 2 of the 53 sources are state school reopening plans (California and Oregon)
• 4 of the 53 sources are from government sources in non-USA countries. The reports are from Australia, Denmark, France, and Hong Kong.
• 2 of the 53 sources are WHO (World Health Organization) web pages.
• 1 of the 53 sources is a public-facing guidance document from a Toronto Children's Hospital
• 3 of the 53 sources are Massachusetts public-facing state web pages.
• 4 of the 53 sources are news articles
• 18 of the 53 sources are peer-reviewed scientific journal articles.
• 5 of the 53 sources are pre-print (not yet peer reviewed) scientific journal manuscripts
• 6 of the 53 sources were scientific journal articles/manuscripts for which peer review status was unclear

Many of the studies cited have an extremely small sample size.

• This study looked at 13 family clusters in Israel.
• This study looked at 39 households in Switzerland. 
• This study looked at 11 people, only one child, in the French Alps.
• This study looked at 18 COVID-19 cases in schools in New South Wales, Australia.
• This study focused on 6 COVID-19 cases in schools in Ireland.

Several locations where studies took place or for which guidelines were written have much lower COVID-19 infection rates than Massachusetts.

• Oregon's infection rate per 100,000 people is over 9 times lower than that of Massachusetts.
• California's infection rate per 100,000 people is less than half of that of Massachusetts.
• France's infection rate per 100,000 is over 6 times lower than Massachusetts.
• New South Wales, Australia's infection rate per 100,000 is over 37 times lower than that of Massachusetts.

Additionally, some of the sources did not prove the claim that DESE attempted to make with them. Of 81 claims made: 

• 7 are not supported by the source cited
• 59 claims are supported by the source cited
• 4 claims have partial support
• 1 claim is somewhat supported
• 4 claims have limited support 
• 4 claims have extremely limited support

Here are some of the unsupported claims (all quotes from DESE guidance):

• "In NYC, in households with at least one COVID-19 case, prevalence of infection for children 5-≤18 was 31.9% vs. overall prevalence 52.5%."
• "Whereas for COVID-19 it appears children are less likely to be infected with and to transmit COVID-19, this is not the case for influenza, where children are frequent transmitters."
• "As noted in previous guidance, temperature checks are not recommended as screening for all students due to the high likelihood of potential false positive and false negative results"
• "Finally, this guidance is for fall reopening and is predicated on the Commonwealth continuing to progress through the phases of reopening with low COVID-19 public health metrics"
• "Mask breaks should occur throughout the day."
• Schools do not appear to have played a major role in COVID-19 transmission. In a review of COVID clusters, only 4% (8 of 210) involved school transmission."
•  "If infected, it appears children may be less likely to infect others with COVID-19."

It appears that DESE cherry-picked data that supported a return to school, rather than looking critically at all available evidence to make a science-based decision about school safety. Inconsistencies in the report, such as inconsistent citation formatting and claims which do not align with the geographical facts of a study, raise concern as to the accuracy of the report. Additionally, the fact that none of the medical professionals involved are named raises questions as to why they do not want their work recognized.

The DESE report also leaves out important research on adult COVID-19 infection risk and transmission data. For schools to open for in-person schooling, numerous adults will need to be in school buildings. There was a recent outbreak in a school in North Carolina amongst the staff. To ignore the data on adult transmission when adults must be present for schools to re-open, is irresponsible. I will write a separate post with some studies about COVID-19 in adults, and school-related COVID-19 cases.

I urge you to contact state level education officials to urge them to reconsider this guidance in light of the dangers to school staff safety. 

• Massachusetts Board of Education: boe@doe.mass.edu
• Massachusetts Secretary of Education James Peyser: eoe@massmail.state.ma.us
• Massachusetts Return to School Working Group: RTSWG@mass.gov
• Massachusetts Governor Charlie Baker contact form or constituent.services@state.ma.us

A Look at DESE's Cited Sources: Footnote #83 - How can airborne transmission of COVID-19 indoors be minimised?

DESE Claim: "Consider ways to increase facility ventilation (e.g., open windows through fall, perform an HVAC inspection)"

Cited Source: Morawska, Lidia, et al. "How can airborne transmission of COVID-19 indoors be minimised?." Environment International (2020): 105832.

Note: no link provided in DESE report citation, I found the article here using Google.

Peer Reviewed?: yes

Study Methodology: unclear

Notes: There may be risk of airborne transmission. "Ventilation airborne protection measures which already exist can be easily enhanced at a relatively low cost to reduce the number of infections and consequently to save lives." This paper gives recommendations of different ways to increase ventilation.

Supports DESE Claim?: Yes

A Look at DESE's Cited Sources: Footnote #82 - Stronger Together A Guidebook for the Safe Reopening of California's Public Schools

DESE Claim: "Where physical distancing is difficult to implement (e.g., office space, reception desks), consider installing barriers or changing the configuration to support student/staff health and safety."

Cited Source: California Department of Education, Stronger Together

A Guidebook for the Safe Reopening of California's Public Schools. (2020, June 8). Available at https://www.cde.ca.gov/ls/he/hn/documents/strongertogether.pdf.

Peer Reviewed?: No - government guidance

Study Methodology: N/A - government document

Notes: This is the California plan to reopen schools. "Install physical barriers, such as sneeze guards and partitions, at point of sale and other areas where maintaining physical distance of 6 feet is difficult." There are provisions for illness, busing, and most other aspects of reopening. "If physical distancing between workspaces or between employees and students and visitors is not possible, add physical barriers that cannot be moved to separate workspaces." California's plan seems to be based primarily on a hybrid model to support physical distancing.

Supports DESE Claim?: Yes

A Look at DESE's Cited Sources: Footnote #80 - How To Clean and Disinfect Schools To Help Slow the Spread of Flu

DESE Claim: "Please refer to the federal guidance related to cleaning of facilities for more information regarding appropriate cleaning supplies, protocols, and frequency (e.g., wear appropriate protection such as gloves, wash hands often, follow instructions on all cleaning products, handle waste properly)."

Cited Source: CDC, How To Clean and Disinfect Schools To Help Slow the Spread of Flu. (2018, July 31). Available at https://www.cdc.gov/flu/school/cleaning.htm

Peer Reviewed?: no - public health guidance on government website.

Study Methodology: N/A - public health guidance

Notes: This page is flu specific, and does not suggest cleaning for COVID-19. 

Supports DESE Claim?: N/A - this is the federal guidance mentioned that schools should refer to.

A Look at DESE's Cited Sources: Footnote #79 - Cleaning and Disinfecting Your Facility

DESE Claim: "Please refer to the federal guidance related to cleaning of facilities for more information regarding appropriate cleaning supplies, protocols, and frequency (e.g., wear appropriate protection such as gloves, wash hands often, follow instructions on all cleaning products, handle waste properly)."

Cited Source: CDC, Cleaning and Disinfecting Your Facility. (2020, April 14). Available at https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

Peer Reviewed?: No - public health guidance

Study Methodology: N/A - public health informational website

Notes: This page contains recommendations on cleaning and disinfecting. It suggests wearing gloves to disinfect, using soap and water before disinfectant, and other measures. There are specific measures for cleaning the facility if someone is sick.

Supports DESE Claim?: N/A - footnote is a reference for where to find federal guidance to be used for cleaning

A Look at DESE's Cited Sources: Footnote #78 - How Denmark got its children back to school so soon after lockdown

DESE Claim: "Prepare for frequent cleaning and sanitization of facilities and surfaces, especially high-touch surfaces (e.g., doorknobs, hand rails)."

Cited Source: How Denmark got its children back to school so soon after lockdown (2020, May 28). Available at https://www.thelocal.com/20200528/how-denmark-got-its-children-back-to-school

Peer Reviewed?: no - news article

Study Methodology: N/A news article

Notes: This article explains the steps being taken as schools reopen in Denmark. "At kindergarten, my four year-old can’t hug or hold hands with her friends but adults can comfort them with cuddles whenever needed." Masks are not common in Denmark, according to the article. "New hygiene guidelines stated that children should wash their hands at least every two hours. Surfaces also needed to be cleaned twice a day." 

Supports DESE Claim?: Yes

A Look at DESE's Cited Sources: Footnote #75 - COVID-19 in Children and the Dynamics of Infection in Families

DESE Claim: "In Switzerland, a study of household clusters found that only 8% had a child as the index case. In nearly 80% of the cases, the child got COVID-19 from an adult family member"

Cited Source: Posfay Barbe, C., Wagner, N., Gauthey, M., Moussaoui, D., Loevy, N., Diana, A., & L'Huillier, A. (2020). COVID-19 in Children and the Dynamics of Infection in Families. Pediatrics, e20201576. Available at https://pediatrics.aappublications.org/content/early/2020/05/22/peds.2020-1576

Peer Reviewed?: yes

Study Methodology: "chart reviews were used to retrieve clinical data and parents were called for patients and household contacts (HHC) follow-up"

Notes: This is a study of COVID-19 cases in Geneva, Switzerland. "Adult HHC [household contacts] were suspected or confirmed with COVID-19 prior to the study child in 79% (31/39) of cases. In only 8% (3/39) of households did the study child develop symptoms prior to any other HHC". There were "confinement measures" in place at the time, though it is unclear if school closures were a part of those measures. 

Supports DESE Claim?: Yes