Can we reopen primary schools? Iceland data suggest: yes (they didn’t close them in the first place)

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Merijn T. Knibbe
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1. Mortality and prevalence of Corona.

Iceland tests a lot and has some of the best, most complete and representative, data on Corona infections (graph above, which is consistent with comparable data for Iceland from surveys, h/t Jesse Frederik) and seems to have come to grips with Corona, for the moment. What do these data tell us about the prevalence and mortality rate of Corona? They show that young people (18-, below another definition will be used) seem to be relatively immune to infection. Other data show that they also get less sick and basically do not die from Corona. Mind: Iceland has a lock down but primary schools are open, the lock down can’t explain the low prevalence of Corona among the 18- generation. The relatively complete data from Iceland also indicate a mortality rate somewhat below 1%, which is more or less consistent with the even lower mortality rate for the German place of Gangelt, severly struck by Corona, which was calculated by Streeck and which was based upon blanket testing. If the around 3,5% infection rate for the Netherlands, based on serological data of Dutch blood donors, is right and doubling the official Dutch deaths to account for people who died of Corona but weren’t tested, we also arrive at a mortality rate of around 1%. Aside: the 14% infection rate for Gangelt seems consistent (even a bit on the low side) with 3,5% for the entire Netherlands as not all parts of the Netherlands are severely struck. About half of Dutch mortality is concentrated in the demographical group of men of 75 and older (Dutch data) which seems to fit in the international pattern. It’s the old who get infected and who die.

2. The moral economy of ageing societies

After 1965 fertility (the average number of children per woman) dropped between replacement rates in one rich society after another (in Iceland only recently, by the way). Long story short: nowadays, there are a lot of old people around. There never has been a time in human history when the number of old people (70+) was as high as it is today in rich countries. This is a burden for the young (70-), even when pension ages increase, as happens almost everywhere. We can expect the young (again: 70-) to carry the connected financial and care burden. We can’t expect them to get unemployed and poor or to halt or even end their education or postpone raising a family and.or pursuing a careers to prevent 75+ males from dying. Period.

3. What to do? Can we reopen the schools?

Let’s reopen schools, primary schools first. What I’m stating below is informed speculation. My ideas might change. But it seems doable to reopen chunks of society – let’s call it society, not the economy – without ending up in a society with an infection rate above 1 (one infected person on average infecting on average one other). Here, a very good explanation by Angela Merkel why we can’t let the infection rate (R0) get above one. Iceland, which does reasonably well when it comes to containing Covid 19, never closed primary schools. Neither did South Korea which also is, at the moment, quite sucessful in containing Covid 19. The Iceland data also show that kids seem to have some natural immunity (as stated, these data are consistent with data from surveys). To be able to do this, we have to continue and even increase other efforts. Fortunately, we can pinpoint our efforts a little more by now. According to my Corona hero,Alex Friedrich of the Groningen UMCG hospital (who got chided by the minister because he did the right thing…), hospitals and care homes can turbocharge infectious diseases with average infection rates which can go up to…20! Sick people in hospitals with insufficient Personal Protection Equipment can infect, on average, 20 other people. All over the western world, care homes provide ample evidence of this presumably well known epidemiological fact which, when I remember my primary school lessons about Koch and my high school lessons about Semmelweis well, not exactly new. Extensive Personal Protection Equipment has to be used not just to prevent workers and patients but also and even especially to prevent further infections. Crush the virus. Just crush it. The immune system of infected people will do this, crushing the virus. Great! Our best and most widely available resource to combat Covid 19. But prevent it from jumping to another host. So, what to do?

• Super spreader events have to be banned for the unforseable future. Don’t even think about starting these up again. Especially events were people sing and shout and deeply inhale in convined spaces, like soccer matches, choir repetitions, the ‘ski hut’ and the like.
• Test, track and trace.
• Hospitals and care homes have to be considered bio hazards. PPPE: professional personal protection equipment (I still have the idea that our armies still must have quite some biological warfare protection stuff – anyway, we easily can produce this even when not always overnight).
• Test, track and trace.
• Social distancing, face masks, hand sanitizer have to keep in place or have to be introduced (masks…). And yes, we can easily produce sanitizer and masks.
• Test, track and trace.
• Lock downs can only gradually be lifted.
• Test, track and trace.
• I have been scornful of ‘herd immunity’ and still am. But if (big if) kids have some kind of natural immunity partial immunity of the older generation (19+) will come around faster even when this partial immunity of kids also means that the R0 for the 19+ generation was higher than originally estimated. This will tend to drive down R0 faster, even when only a little faster. I might rethink this, by the way. Mind however that the best estimation of the immunity rate in the Netherlands is a mere 3,5%!
• Test, track and trace.

There is no guarantee that R0 below 1 without at least a partial lock down. The alternative ‘let 80+ men just die’ is not an alternative as any R0 above 1 will, eventually, swamp the hospital system (even the German one, according to Merkel, which has much more ICU units per capita than most other systems).

But we have to try. Old people deserve to live. Young people to have a live.

Methodological note: the Icelandic researchers recently changed the categories used in the graph from 0-9, 10-19 etc. to school ages. Good!