40M teachers, adults living with schoolchildren have 'definite or possible risk factors' for severe Covid-19
The findings underscore the need for careful consideration of and preparation for school reopenings this fall, say experts
As the debate continues over the reopening of schools this fall, a new analysis from researchers at Harvard Medical School and the City University of New York’s Hunter College sheds light on the risks for adults who work or live in close contact with schoolchildren in the US. They found that 37.7 million American adults, who live with school-age children, and 2.9 million teachers have medical conditions that increase their risk of severe Covid-19.
The authors analyzed nationally representative data from the 2018 National Health Interview Survey to determine risk factors for severe coronavirus illness among teachers and adults living with school-aged children. They used the Centers for Disease Control and Prevention’s criteria to define ‘definite’ and ‘possible’ risk factors for severe Covid-19 illness, including differing severities of obesity and tabulated their prevalence among three groups: employed adults other than teachers, adults employed as teachers, and adults living with school-aged (5 to 17 years) children. The team assessed differences in the prevalence of definite or possible risk factors among adults living with children according to the children’s ages (5 to 10 years versus 11 to 17 years), race/ethnicity, and family income.
The National Health Interview Survey sample included 14,097 adults representative of 150.3 million US non-teacher workers, 592 adults representative of 5.8 million primary, secondary, and special education teachers, and 5682 adults representative of 69.7 million adults living with school-aged children. The analysis reveals that 2.3 million school teachers and 28.6 million adults are either over 64 years or have chronic diseases that put them at high risk of severe Covid-19. An additional 630,000 teachers and 9.05 million people living with children have conditions that may increase their risk, according to the researchers.
“About 40 million US adults who work or live with school-aged children have definite or possible risk factors for severe Covid-19 illness, a number that excludes 4.4 million non-teachers working at schools and 1.6 million daycare workers. Adults living with Black children and those living with children in low-income households are at especially high risk. Teachers’ risk seems similar to that of other working adults,” write researchers in the study published in the Annals of Internal Medicine.
Among teachers, 39.8% had definite and 50.6% had definite or possible risk factors for severe coronavirus illness. While 0.7% had cancer, 27.9% had a body mass index (BMI) of 30 or greater, 4.2% had a BMI of 40 or greater, and 8% had a cardiac condition. A BMI between 18.5 and 25 indicates a normal weight. While a BMI between 25 and 29.9 is considered overweight, a BMI of 30 or higher is considered obese. “Different risk factors and different levels of obesity carry different levels of risk for severe Covid-19 illness. A BMI 45 and higher, for example, more than quintupled the risk for Covid-19-related death, whereas a BMI of 30 to 34 increased it by 26%,” the findings state. The prevalence of most risk factors was similar among non-teacher workers, but more were smokers, 41.4% had definite risk factors, and 55.8% had definite or possible risk factors.
Among the 69.74 million adults living with school-aged children, 41% had definite and 54% had definite or possible risk factors. This includes 2.50 million who were older than 64 years, 4.67 million with heart disease, 4.84 million with type 2 diabetes, and more than 600 000 with cancer. “We could not identify school personnel other than teachers or day care workers in the National Health Interview Survey, nor could we identify some conditions identified as risk factors for severe Covid-19 illness, such as chronic kidney disease or thalassemia. Hence, our estimate of the number of adults at risk is likely too low,” the team cautions.
The authors found that the prevalence of risk factors was similar among adults living with younger versus older children. Adults living with children in low-income households were more likely to be at risk than those in higher-income households, as were those residing with Black children. Adults living with Asian children or children of other races/ethnicities were at the lowest risk, says the study. According to the research team, the findings underscore the need for careful consideration of and preparation for school reopenings this fall. The resumption of face-to-face instruction is critical for children’s development, health, and welfare, but without adequate safeguards, reopening schools could put millions of vulnerable adults at risk for severe Covid-19 illness, they emphasize.
“By mid-March 2020, 107 nations had closed schools to help contain the Covid-19 outbreak. Many that have suppressed the virus are now reopening them. In-person instruction is preferable for children’s educational and social development, and school closures may adversely affect children's mental health, food security, and safety. Moreover, children rarely develop severe Covid-19 disease. However, as our findings indicate, school leaders must weigh these undoubted benefits against the risk to the adults who care for children, particularly older children who commonly transmit the infection. Both the risks and benefits of schools reopening are likely larger for poor and Black families,” the authors conclude.