11 COVID safety measures that are a must for districts

In a National PTA webinar, infectious disease physicians answered questions from parents and teachers on COVID-19's impact on children and youth and what current information indicates about how to mitigate risks for transmission in schools.

As state and local education leaders continue the arduous work involved in getting schools ready for a reopening—whether it’s for the first day of the school year or some point later—the logistical and financial concerns multiply. At the same time, rates of infection are skyrocketing in many areas of the country and district administrators are hearing concerns about whether it’s even safe to reopen from every constituency corner.

The National PTA held a virtual event to address some of these concerns and provide advice related to various aspects of reopening. It was moderated by John B. King Jr., president and CEO of The Education Trust, a national nonprofit that seeks to identify and close opportunity and achievement gaps. The panelists were Dr. Tina Tan, of Northwestern University Feinberg School of Medicine and Lurie Children’s Hospital of Chicago, and Dr. Wendy Armstrong of Emory University School of Medicine. Both serve on the board of directors for the Infectious Diseases Society of America, which co-hosted the event along with several education associations.

What do we know about children and COVID-19 infection?

Tan noted that we can look at data from countries around the world where schools have reopened. Denmark and Finland fared well and had included measures like social distancing and staggered openings. They had low community viral transmission at the time. Israel, on the other hand, had a well-publicized outbreak and has been criticized for reopening too quickly and not enforcing safety measures like mask-wearing.

To date, children make up about 7% of all COVID-19 cases in the U.S., and that children under age 10 are much less likely to get infected than children over 10 and adults, Tan said. That means school districts may consider different protocols for young children versus older children and teens.

In social distancing, how far apart do children need to be from each other?

Both three and six feet have been discussed extensively, with studies showing that at least three feet apart is important. As educators know, that’s a big difference in terms of effort needed to separate desks in classrooms. The American Academy of Pediatrics has suggested that three feet may be sufficient if face coverings are used. But the magic number isn’t clear. “We don’t yet have the data to guide whether it should be three or six,” said Armstrong.

When will it be safe to open schools? Should we wait for a vaccine?

“Places of explosive growth are probably not where you want to be fully opening schools,” said Armstrong. It’s going to be really important to stay focused on the COVID case counts in each community’s population to determine if it will be safe to open schools, Tan added.

Some states have relatively small numbers but they’re rising quickly,” Armstrong said. “Others have enormous numbers rising quickly. What you want to see is significant reductions, a downward trend for at least a few weeks”

On the vaccine front, Tan noted that there won’t be a vaccine is still a long way off. “Right now the vaccine [waiting idea] needs to be taken off the table because we’re not going to have it at the time we are considering opening schools.”

Districts should consider how they can encourage children to get up-to-date on other immunizations, since immunization rates are down significantly in light of the shutdown, she added.

What should go into parent and teacher decisions on returning to school buildings?

While individual situations of course vary, Tan suggested that parents and teachers look to make sure safety protocols are in place—from screening for illness to hand hygiene and mask mandates.

Armstrong advised ensuring there are plans for both access to testing and contact tracing as well.

“The fine details of the answers matter less if there’s a thoughtful plan that addressing all of this,” Armstrong added.

In a webinar participant poll, 72% feel either very or somewhat unconfident that it will be safe for students and teachers if schools reopen fully for the start of the year.

How important is it to weigh other problems impacted by school closures against the risks of reopening?

“It’s an individual decision and I think a lot of it is driven by what’s known academically,” Tan said. “We know especially that younger kids don’t learn as well when everything is virtual. They need the stimulation of in-person learning to basically develop some of the skills that they need. That has to be weighed against the risk for these kids to go to school in an in-person setting.”

What kind of personal protective equipment is best?

“The risk of getting COVID is related to the time you’re with somebody and the exposure,” said Armstrong. “We think a lot about teachers and eye protection and masks. How do you think about the custodians and cafeteria workers? Cafeteria workers are face-to-face with students to offer a meal.” Districts keeping cafeterias open can install plexiglass guards between students and employees.

The face shield option

Although masks are a more familiar safety measure, schools are considering instances where face shields may be most appropriate for some teachers and students. A recent article in the medical journal JAMA detailed the use of face shields in containing COVID-19.

Consider also a school counselor and the one-on-one time in a small space. “Probably again you would want to be very careful about masking,” she said.

A custodian, on the other hand, is going to have less face-to-face time, so PPE at all times isn’t as necessary.

She also cautioned about adults taking off their masks during lunch time in break rooms as they eat and talk to other adults. Schools should plan for other spaces where adults in the building can eat.

Students must also wear masks, Armstrong added. “There’s no questions that masks work so to the extent we can encourage and help students wear masks it’s critical.” She said schools must really emphasize mask use, particularly for students age 10 and up.

But, said Tan, if younger students are physically distanced by six feet for a period of time, perhaps they could remove their masks during that time if the teacher is wearing a mask or shield.

Because eye protection is helpful and some students need to see facial expressions to access their education, Armstrong said having face shields available is another consideration. It’s an option for students unable to wear masks, as well.

How important is ventilation?

“In crowded, poorly ventilated settings COVID spreads more readily,” said Tan. “If schools can hold classes outside, maybe in playground under a tent, there’s better ventilation. Open the windows in the rooms to try to ventilate. I know that’s a challenge because many school buildings around country are quite old so ventilation in rooms is definitely not optimal. School systems are going to have to think about maybe changing the filters on systems. But in those schools without air conditioning systems, prob opening a window is best way to ventilate a crowded room.”

When a school community member tests positive for COVID, what should happen next?

Administrators are pondering whether a small group such as a class should quarantine or whether the whole school must close.

“The first thing is recognizing the case,” said Armstrong. That involves having screening protocols in place. If an ill student is discovered at school, staff should quickly remove him or her from the classroom setting and to an isolated place to be evaluated. It’s about getting the student out of the building and then initiating a plan specified in advance. “There need to be protocols so this is not made up on the fly,” she said. “That may include quarantining a cohort of individuals the student has been in association with. Districts may choose to shut down an entire school, but if the cohorting is strict it may not be required.”

Tan agreed about the advanced planning. “That protocol needs to be in place before the school opens. You don’t want to have everyone running around not knowing the next step,” she said.

Also consider whether the student testing positive was able or not able to wear a mask. If it’s an older student and everyone was masked and six feet apart at all times, that may not call for a full closure, Armstrong said. “Those are the kinds of nuances that individual communities need to be sure that they have a plan for.”

How safe will student activities be this fall?

“Many extracurriculars worry me,” Armstrong said. “One is choral events. We have already seen outbreaks in choirs. The act of singing expels a lot of air. Band instruments are challenging for many of the same reasons, whereas in orchestra you can socially distance. The same is true for sports. There are outbreaks among teams that practice together. But if your team is golf, you may not have that risk.”

So overall, the answer depends on the activity.

What about transportation and school arrivals?

“You’re going to have to stagger some of that depending on whether or not you’re staggering classes attending school on different days,” Tan said. “Buses are a challenge. You want to be able to distance everyone, and everyone needs to be wearing a mask and the bus driver maybe needs plexiglass so he’s not exposed to people. And you shouldn’t have adults on the bus who don’t need to be on the bus.”

One thought is to have kids spaced in every other row with assigned seating. “It’s going to be really hard for some school districts,” she acknowledged.

“This discussion brings back the concern about equity,” Armstrong said. “Schools that are more crowded and rely more on transportation are at a little bit of a disadvantage. And school districts can’t bear the burden of that.”

In a poll, 98% of event participants believe Congress should allocate additional funds to schools before the start of the 2020-21 school year.

What else can be done to help schools open safely?

“Not only do we need a national plan for schools, we need a national plan for everyone,” Armstrong said. “I implore everyone to wear face masks. If we can get community transmission under control, we can go back to school with a lot fewer dollars needed to do that.”

Tan agreed. “Schools can’t do this alone,” she said. “They can’t exist as this perfect bubble. We need financial resources and a national plan to get us through this pandemic.”

A recording of the event is accessible at the National PTA Facebook page.

Melissa Ezarik is senior managing editor of DA.

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