As different countries and states tentatively start reopening their economies, there seems to be no clear plan, and no clear way to figure out which of the lockdown measures made a difference in slowing the spread of Covid-19.
Was it necessary to shut down schools? Did it matter if state parks and playgrounds in New Jersey were closed? Did an 8 p.m.-to-5 a.m. curfew make a difference? When can we go back to normal?
With so many restrictions in place in different regions and countries, and with so many different ways of lifting them, it can seem impossible to draw conclusions.
Now, two Norwegian medical researchers, experienced in evaluating cancer data, suggest a way to get reliable information. Their answer: a randomized clinical trial of reopenings.
Its design could be analogous to some studies asking, for example, if cancer screening lowered death rates. The results, they add, should be generally applicable. If such a study is done in Norway, its findings should apply to the United States, too.
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The researchers, Dr. Mette Kalager and Dr. Michael Bretthauer, a husband-and-wife team at the University of Oslo, do not suggest randomizing individuals, as is done in studies of experimental drugs, but rather randomizing regions like similar school districts in adjacent towns.
To test whether it was safe to open schools, they envision what is called rapid-cycle randomization, in which measures are quickly evaluated and adjusted as data emerge.
In the first cycle, schools in one district would remain closed while those in another would reopen carefully with, for example, half the usual number of students and with six-foot social distancing in place. Students and teachers in both districts would be tested for the coronavirus at the start and end of the cycle. Each cycle could last between 10 days and two weeks, accounting for a viral incubation period of four to five days.
If the careful reopening did not result in increased transmission of the virus, the study would advance to the second stage: Schools in one district would open with half the normal number of students and six-foot social distancing while those in the other would have three-quarters of the normal number of students and maintain just three feet of social distancing.
If there were no increased transmission, the third phase would compare that less restrictive setting with a full, unrestricted reopening.
In the best-case scenario — no increased transmission — all schools could open after three to six weeks.
Dr. Kalager and Dr. Bretthauer add that the study would minimize harm because only those randomized to the increasingly lax restrictions and those they came in contact with would be at risk.
The same trial design could, in theory, be applied to places like gyms and office buildings.
Epidemiologists and medical researchers in the United States say the idea is worth considering, although it is not clear how practical it would be to carry out.
“The general idea is a good one,” said Jon Zelner, an epidemiologist at the University of Michigan. The data that will emerge from the reopenings that are starting now will be analyzed, he said, but it’s not clear how useful that data will be because the reopenings are being done “in a very ad hoc, not rigorous way.” Although he questions the details of how a randomized study could be designed, or whether a randomized trial is the best way of answering these questions, he said, “just the contribution of the idea to the discussion is valuable.”
Dr. Robert Aronowitz, a professor of the history and sociology of science at the University of Pennsylvania, added that a rigorous study might be more convincing to a skittish public than data from observations of a variety of reopenings.
But, Dr. Kalager and Dr. Bretthauer said in a Zoom interview, it is not always in politicians’ interest to get data from randomized controlled studies. Those who called for quickly shutting schools down would face blowback if it turned out that the closings had virtually no effect on the spread of the epidemic.
So far, a study like the one they propose is just a thought experiment. No schools in Norway are planning to randomly test reopenings. Gyms are interested — they have everything to gain if they can prove it was safe to open up — but Dr. Kalager and Dr. Bretthauer said they were still studying how to best design a gym experiment.
But, Dr. Kalager said, “we are really pushing this, talking to local and national politicians.”
“If it takes one and a half years to develop a vaccine,” she added, “we can’t close down the schools for one and a half years.”
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