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Public Choice

Erschienen in:

24.07.2021

The incidence and magnitude of the health costs of in-person schooling during the COVID-19 pandemic

verfasst von: Casey B. Mulligan

Erschienen in: Public Choice | Ausgabe 3-4/2021

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Abstract

The health costs of in-person schooling during the pandemic, if any, fall primarily on the families of students, largely owing to the fact that students significantly outnumber teachers. Data from North Carolina, Wisconsin, Australia, England, and Israel covering almost 80 million person-days in school during 2020 help assess the magnitude of the fatality risks of in-person schooling, accounting for mitigation protocols as well as the age and living arrangements of students and teachers. The risks of in-person schooling to unvaccinated teachers are, for those not yet elderly, small enough to challenge comprehension. Valued at a VSL of $10 million, the average daily fatality cost ranges from $0.01 for a young teacher living alone to as much as $29 for an elderly teacher living with an elderly spouse. For each 22 million unvaccinated students and teachers schooling in-person for a 5-day week during the pandemic, the expected number of fatalities among teachers and their spouses is one or less.

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The precautions usually included face masks, restricted school entry, extra spacing, cohort arrangements, reduced class sizes, daily symptom screening, and cancellation of extracurricular activities (Lessler et al., 2021). See also Oster et al. (2021) and van den Berg et al. (2021).

Moreover, the authors cite three other studies (Goldhaber et al., 2021; Harris et al., 2021; Isphording et al., 2020) looking at community prevalence, which they characterize as “find[ing] little evidence that reopening schools increases COVID-19 spread on average.”.

Non-teaching staff also would bear some of the burden to the extent that they are present with students or teachers during in-person schooling. Before the pandemic, 73% of the staff in public primary and secondary schools were teachers (National Center for Education Statistics, 2020, Table 213.10).

Such sharing overstates the individual’s risk because acquiring infection from one family member may avoid being infected by a second family member. However, given the low in-school infection rates, the overstatement is miniscule.

The CPS is conducted on the week including the 12th of the month. In 2020, the week of March 12 was the week before most schools closed during the pandemic.

By these definitions, the national total of CPS students per CPS teacher is only 9.9, in part because not all persons indicated as teachers in the CPS are in the classroom every day. The total CPS students by this definition is 51.6 million, as compared to 56.4 million elementary and secondary school students reported by NCES.

Although it is not the focus of their study, Vlachos et al (2021) estimate a secondary attack rate of 52% specifically from Swedish teachers to their spouses. Cutting the assumed household transmission rates in half reduces my estimates of teacher-family fatality risk (Table 6) by 13%.

Yang et al. (2021, p. 206) “estimated an overall infection-fatality risk of 1.39%”, ranging from 0.00972% for under age 25 to 14.2% for age 75 and over.

For what it is worth, no study of the fall 2020 term reports more in-school infections among staff than among students.

For example, one study reports only median attendance rather than mean attendance.

The English study (Ismail et al., 2020) refers to all in-school transmission as “outbreak”. This paper refers to an outbreak as enough transmissions in a single school over a short time horizon that the school was closed.

The study acknowledges that persons in the same school sometimes interact outside of school. The study also notes that only one teacher in England died from COVID during this period, which was acquired from a spouse who acquired it in the community. Regarding the information available for monitoring transmission, the authors note that “PHE has legal permission … to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required.”.

Whenever rescaling is performed in this paper, it takes the inverse school-acquired infection rate from the study, multiplies by the positivity rate for the locality where the study occurred, and divides by the positivity rate for the U.S. (or other area such as Vermont, as specified by the infection scenario). The result is the rescaled inverse school-acquired infection rate. As noted in the tables, case rates are used for England rather than positivity rates. Also note that both inverse-infection entries in Table 2 for England have been reweighted to reflect a 15.4 pupil-teacher ratio rather than the ratio of 1.3 that prevailed during the study.

All close contacts were quarantined for 14 days.

In principle, asymptomatic secondary cases would be included among the 32 because testing of contacts “was encouraged by NCDHHS, but not required” (Zimmerman et al., 2021).

Scheduled in-person days per week were measured from school district websites (Pittsville School District, 2020; Port Edwards School District, 2020a, b; School District of Auburndale, 2020; School District of Marshfield, 2020; School District of Nekoosa, 2020).

At the time of my writing, cumulative US cases represented 9% of the population, with new cases added at a rate of about 50,000 per day.

For the purposes of estimating fatalities with the Yang et al. (2021) parameters, the distinction between deaths per infection and deaths per confirmed case is minor because Yang et al. find 1.4% for the former whereas, through mid 2021; Centers for Disease Control and Prevention (2021) finds 1.8% for the latter.

For the purposes of Table 3, the daily rate includes weekends.

The CDC age distribution of cases, which it calculates cumulatively for most of the pandemic, is rescaled to match new national daily infections during fall 2020. Age-specific daily infection rates for the fall are found by dividing age-specific daily infections by the national population in that age group. The results shown in Table 3 are inverse weighted averages of the age-specific daily infection rates.

Vlachos et al. (2021). Moreover, “student absenteeism increased [during the pandemic], but not dramatically so.” See also Ludvigsson et al. (2021), who observed that Sweden had “no enforced quarantines for infected households or geographic regions, and facemasks were not recommended outside health care.”.

The study notes two index cases that came into the school from the community (Stein-Zamir et al., 2020).

Because this paper focuses on primary and secondary schools, in which face-to-face student learning normally occurs 180 days per year, when necessary, I adopt a factor of 180 to convert between person years and person days. Both driver and passenger(s) count in the numerator for automobile fatalities.

According to the National Safety Council (2020), 345 motor-vehicle crashes occurred for every crash-related fatality.

Children living with teachers are ignored in these calculations because their fatality rates are so close to zero. Note that the first column of Table 1 is the product of the first two columns of Table 6.

Recall from Table 2 that, adjusted for positivity rates, the in-school transmission rate in North Carolina was somewhat greater than both England and Wisconsin. In this sense, building the “middle” scenario on North Carolina is somewhat conservative.

As noted previously, a student infection occurring at school that is taken home and transmitted to a parent counts as “school acquired”.

According to Kniesner and Viscusi (2019), $10 million is in the middle of the range of estimates of the US VSL. Readers readily may apply alternative VSL values by rescaling Table 8 proportionally. The robust conclusion is that the in-person compensating differential is often just pennies per day, which is an opportunity cost dwarfed by the more familiar opportunity costs of schooling.

The primary- and secondary-school rates herein may be less than college rates not only because college students are older but because colleges provide both classrooms and living quarters. However, at least some college dorms drove infection rates an order of magnitude below those in surrounding communities (Mulligan, 2021b).

Assuming that learning occurs remotely at half the rate that it does in person, Mulligan (2021a) estimates that the pupil human-capital loss from remote learning is $666 per teacher per day as compared to health benefits (if any) that are less than $30 per day (Table 8 of this paper).

The 37,994 teacher-years refer to the population-weighted harmonic mean of Table 6’s rescaled North Carolina column. The risk would be 34% lower if the non-elderly, who represent 95% of the workforce, did all of the teaching during the pandemic.

For some of the papers on the accuracy of consumer risk assessments, see Kahneman and Tversky (1979), Fischhoff et al. (1981), Viscusi (1985) and Magat et al. (1988). One emerging theme is that people overestimate small risks when the risks are not part of their consumption specialty or profession, as with nonsmoker overestimates of smoking risk (Viscusi, 1990) or occasional Israeli bus users’ overestimates of the frequency of terrorist incidents (Becker and Rubinstein, 2011).

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