Weeks before Arkansas schools are required to reopen in-person for students, most counties fail a measure that federal officials say is key to returning safely in the covid-19 pandemic, an Arkansas Democrat-Gazette analysis of public data has found.
The newspaper's review of Arkansas Department of Health data found that more than two-thirds of the state's counties -- as well as the state as a whole -- have recorded 5% or higher positive results for diagnostic tests for the virus.
[CORONAVIRUS: Click here for our complete coverage » arkansasonline.com/coronavirus]
National health leaders, including federal Centers for Disease Control and Prevention chief Dr. Robert Redfield, recently have cited a 5% or lower test-positivity rate as an important indicator that spread of the novel coronavirus is under control.
Hot spot areas "might need" to adopt remote and distance-learning options, deputy education secretary Mitchell Zais said in a recent call with Redfield and reporters.
The positivity rate is the percentage of total covid-19 tests administered for a designated area that return positive for the virus. The 5%-and-higher finding in more than two-thirds of Arkansas' 75 counties is true both for cumulative tests since the pandemic began and county-specific, seven-day rolling averages as of Aug. 1.
Schools across Arkansas are now required to offer in-person instruction starting the week of Aug. 24.
Redfield, according to a transcript of his call, went on to say that areas with 10% and higher positivity test rates should be "particularly" cautious.
Forty of Arkansas' 75 counties had rates at 10% or higher as of Aug. 1, the newspaper's analysis found.
Pediatric infectious-disease specialist Dr. Tina Q. Tan of Northwestern University said in an interview that she believes areas with 20% or higher positive test rates "definitely should not" open schools for in-person instruction.
Eight of Arkansas' counties recorded 20% and higher average rates as of Aug. 1. The average was 31.6% for Yell County -- that highest in the state, according to the newspaper's analysis.
Independence, Johnson, Union, Chicot, Little River, Mississippi and Poinsett also had rates at 20% or higher.
The "number one" thing has to be safety, said Tan, a professor at Northwestern's Feinberg School of Medicine and a physician at Ann & Robert H. Lurie Children's Hospital of Chicago.
"You're talking about people's lives here," she said. "It's fine if you want to open a school -- but you have to do it in a setting where you're having low community transmission rates."
According to the Redfield call transcript, "The majority of the nation right now actually has positivity rates for covid-19 tests of less than 5%."
Only 13 Arkansas counties had test-positivity rates of 5% or lower, according to the seven-day rolling average from Aug. 1. They were Cleburne, White, Monroe, Woodruff, Conway, Grant, Baxter, Fulton, Jackson, Polk, Ouachita, Clay and Perry counties. For cumulative averages, 23 counties came in under 5%.
Gov. Asa Hutchinson has acknowledged high test-positivity rates in Arkansas but has stayed firm on plans to reopen schools for in-person instruction. The state has required that most schools offer a face-to-face teaching option five days a week. Parents can choose all-virtual instruction instead.
Another national expert to talk recently about positive test rates and schools was White House coronavirus response coordinator Dr. Deborah Birx, speaking on CNN last Sunday.
"If you have high caseload and active community spread, just like we're asking people not to go to bars, not to have household parties, not to create large spreading events, we're asking people to distance learn at this moment so we can get this epidemic under control," Birx said.
A separate White House report said that during the week of July 25-31, Arkansas' test-positivity rate statewide was 11.1%, and 37 of its 75 counties were in the "red zone," meaning they reported rates of more than 100 new cases per 100,000 population and had test-positivity rates higher than 10%.
Those measures should trigger restrictions, the report said, though it wasn't specific to schools.
Officials have stressed the complexity of deciding whether to reopen primary and secondary schools. Ripple effects on the economy, needs of working parents, food insecurity, and children's social and psychological well-being all factor in.
In a statement, Hutchinson said the school year had been delayed "to give our communities more time to reduce the spread of the virus."
School districts must be prepared to shift to online learning "in the event there are positive cases in a school" or at the recommendation of the Health Department because of community spread, he wrote. He said with more than two weeks to go before the school year begins, there's been a "flattening" of cases.
Arkansas reported 5,528 new covid-19 cases in the first seven days of August.
Health Secretary Jose Romero said at a news conference Thursday that he's hopeful a statewide mask mandate that went into effect July 20 will drive down case counts in advance of school starting. He said he supports the decision to reopen classrooms and that numbers of new cases are not climbing "significantly."
State officials have not placed particular emphasis on test-positivity rates.
"CDC has not released any documents that suggest a definite, set positivity rate at which schools should not open for in-person instruction, nor have they suggested that positivity rate is the only metric that should be used to make this decision," Health Department spokeswoman Meg Mirivel wrote in an email.
The rate "does not tell the whole story," she wrote. High positivity rates can come from targeted testing, such as in prisons, nursing homes or occupational clusters, she said.
The state's high rates also hold up across its five public-health regions, the newspaper's review found. None averaged a cumulative test-positivity rate of 5% or lower. The highest rate was the 14-county southeast region, which averaged an 11.6% positivity rate Friday.
Some data reviewed by the newspaper was approximate because of rounding. Rates are also rounded for this article.
Dr. Aaron Strong, a pediatrician with Little Rock Pediatric Clinic, said the 5% test-positivity rate is something of a "line in the sand" to help decision-makers. Hospitalizations and case counts also are important metrics, he said.
While clarifying that he's not an epidemiologist, recent trends are concerning, he said. He worries that many classrooms can't be set up safely -- for example in some older buildings, where windows are painted shut and can't be opened to increase ventilation.
"I think that everybody's concerned that even if schools do open in person, that they may not stay that way for very long," Strong said.
The community transmission rate "does need to be low" to open schools safely, said Kathleen Winter, epidemiologist at the University of Kentucky's College of Public Health.
She said test-positivity rates are only one piece of a larger puzzle to assess risk, and hospitalizations and testing availability should be figured in. While it's difficult to come up with a "blanket" recommendation for the test-positivity figure, she agreed with Redfield, Birx and others that a 5% or greater positive test rate likely shows widespread virus.
"Right now we're in a situation, in many places, where it's inevitable that schools that do open will have cases immediately," Winter said.
'ADAPT, ADJUST'
Federal officials have mentioned the 5% positivity rate in public remarks only recently.
Few public documents offer guidance on the exact measurements to evaluate before reopening schools.
The "overall level of community spread," defined as active cases per population, factors into schools' response levels, an Arkansas Department of Education plan updated Aug. 3 reads.
It doesn't say what infection rates, test-positivity rates or other measures would cause schools to pause opening plans, saying that the agency will work with the Health Department.
A Department of Education spokeswoman said that's because districts come in many sizes, so different numbers of cases will have varied impact. She deferred a question on test-positivity rates to Health Department officials.
CDC documents published in late July describe reasons why schools are important, and include discussions of symptom screening and what other countries did to open classrooms. One "operating schools" guidance was last updated in May.
Schools are allowed to reopen under Phase 2 of the federal "Opening Up America Again" plan, which Arkansas entered June 15. But the state does not meet the criteria to remain in that phase or move into the next one: "no evidence of a rebound" or a 14-day downward trajectory of cases or of positive test rates.
Hutchinson previously said the phase guidelines are not "sacrosanct."
Last week, asked whether a specific number or threshold existed that would make him revisit the idea of reopening schools, the governor said he wants to move forward statewide.
"If we have to adapt and adjust from that down the road, we'll adjust. ... That's the game plan," Hutchinson said.
Northwestern University's Tan said schools reopening and then being forced to shut down again "is definitely going to be more disruptive to a child's education."
"If you're going to do this, you have to do it right," Tan said.
Arkansas Education Association president Carol Fleming said in an interview that association members are "concerned" about what high test-positivity rates suggest. As reopening nears, the group worries for teachers, students and communities, she said.
"What we know is that this virus, it doesn't recognize or respect school district boundaries," she said. "We have to use that medical data. And right now the medical data says, it's not safe."
RISK ISN'T ZERO
Discussing the test-positivity analysis and school reopenings broadly, some experts said it might be best for Arkansas to move away from an "all-or-nothing" approach to declaring schools open statewide. A district- or county-based plan allows closer attention to local data, they said.
Even in areas with "moderate" spread of the virus, some schools should likely open to "students for whom in-person learning is really the only option," Julie M. Donohue, health policy professor and vice chair for research at the University of Pittsburgh School of Public Health wrote in an email.
That option could be reserved for children with disabilities, very young children and children from families with low incomes, who most benefit from the setting, she said.
She urged schools, if and when they open, to take steps such as physical distancing, face coverings and keeping kids in classrooms for lunch. The Health Department also has moved to expand rapid-result testing at local health units to assist with testing for schools.
Dr. Jessica Snowden, chief of the pediatric infectious disease section at Arkansas Children's hospital, said a return to the classroom is right for her fourth-grader. However, scientists are still learning how the virus affects and is spread by children, she said.
She recommended that in deciding whether in-person or remote learning works best for a family, the parents should talk to a pediatrician about health factors that put a child at risk of serious illness. Factors include respiratory illnesses, sickle cell disease or taking medications that weaken the immune system.
For kids who get covid-19, "the risk is less than in adults, less than what we're seeing in our elderly -- but it's not zero," she said.
As the school year approaches, some Arkansas doctors' groups are also expressing apprehension.
The Arkansas chapter of the American Academy of Pediatrics put out a statement in July recommending against opening schools statewide, noting ongoing transmission of the virus and potential impact on hard-hit Black, Hispanic and Marshallese families in the state.