With no unified national policy, parents, teachers, and kids need solid answers.

By Karen Pallarito
August 19, 2020
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Right now, kids across America should be enjoying the last licks of summer, as parents stock up on notebooks and pencils and gear up for the first days of the new school year. Instead, many families are sitting on pins and needles, uncertain whether schools will actually open this fall and, if they will (or already have), if it’s safe to send kids back.

Whether classes will resume in person depends a lot on geography. In California, most schools will remain closed for in-person learning this fall, and to reopen, they'll have to meet strict health benchmarks. In Texas, local health officials cannot close schools preemptively; they can close only after cases of COVID-19 have been reported.

Schools in parts of Georgia, Tennessee, and Indiana recently opened their doors for in-person learning, only to shutter again as COVID-19 infections forced hundreds of students and staff into quarantine. Reopening schools amid a national pandemic is a logistical feat at best, say public health experts. In swaths of the South and Midwest where cases of the virus are on the upswing, it may be an exercise in futility.

While some K-12 schools and universities are switching to fully remote classes for the fall, others are navigating the pandemic through hybrid models that combine in-person and online instruction. Parents naturally want to do the right thing for their children as well as other vulnerable household members—but what is the right thing? Is it safe to send kids back to school? Is it better—or worse—to keep them home?

Christa Thompson, a single mom and professional travel blogger in Cherokee County, Georgia, a suburb of Atlanta, ultimately decided to send her son back to the classroom on August 3. If her son, a 6th-grader at Creekland Middle School, had been younger and less mature, she might have made a different decision. But she felt the cautious 11-year-old would be responsible about keeping himself safe, wearing his mask, and washing his hands. Plus, being in school would allow him to be engaged socially as opposed to being stuck at home. “I really think it’s a personal choice,” she tells Health. “Every kid is different.”

Initially, Creekland had one confirmed case of coronavirus, forcing 20 students into quarantine. As of August 18, another child tested positive, and 28 more were quarantined. Many of the students have older siblings who attend Creekview High School just across the street. Cherokee County School District announced Sunday it would immediately close the high school for in-person learning after confirmed cases there climbed to 25. Five hundred of its 1,800 in-person students are now in quarantine.

Without a uniform, national strategy for reopening schools, policymakers at the local level are making the tough calls. The US Centers for Disease Control and Prevention (CDC) weighed in with guidance, as have various health and education advisory groups. Overall, the recommendations for getting kids back to school fall into three broad categories.

One factor to consider is the number of people who have tested positive for coronavirus in the local community: Is it low and controlled, or out of control? Another is whether schools have appropriate measures in place to protect kids, teachers, and staff. Does the district have guidelines for masking up and social distancing? Will school health staff be provided with personal protective equipment?

No matter how schools proceed, families’ personal circumstances may be the deciding factor. Maybe they have children or family members with preexisting health conditions that could put them at risk of serious illness from COVID-19; those families would prefer keeping their kids at home. Others may have a child at risk of falling behind academically if there’s no in-person learning. And working parents’ hands may be tied: Who’s going to supervise their child’s virtual instruction when they’re not home?

Dan Domenech, executive director of AASA, The School Superintendents Association (AASA), hears from educators tasked with rolling out plans for the 2020-2021 school year. “I’m telling you, these individuals are despairing every day because they know they’re making decisions that affect the lives of thousands of children and staff members,” he tells Health. And yet he sees communities, particularly in the South, where schools are opening up, going about “business as usual”—no physical distancing, no mask mandate. If children or staff fall ill or die, says Domenech, “your career is over.”

Politics threaten to taint school reopening decisions

In late June, the American Academy of Pediatrics (AAP) weighed in on the matter, issuing guidance emphasizing that school re-entry policies “should start with a goal of having students physically present in school.” The Trump administration quickly seized upon that message to advance its own back-to-school narrative, even threatening to cut federal funding to schools that fail to fully reopen.

Two weeks later, AAP issued a joint statement with the American Federation of Teachers, National Education Association, and AASA underscoring the importance of getting children back to school safely. “Returning to school is important for the healthy development and well-being of children,” they agreed, “but we must pursue re-opening in a way that is safe for all students, teachers, and staff.” Science and community circumstances, not politics, must guide decision-making, the organizations insisted.

The White House continues to press for schools to open. As recently as August 12, Vice President Mike Pence and US Secretary of Education Betsy DeVos doubled down on the President’s message during an education-focused event in the State Dining Room. “We know that it’s best for our kids. We don’t want them to fall behind, academically,” Pence argued. “But also, we don’t want our kids to miss out on the counseling that they receive, special needs services, as well as all the nutrition programs that are available just at our schools.”

Weighing the pros and cons of reopening schools

Epidemiologists and educators don’t dispute the significant benefits of being physically present in school. In mid-July, the National Academies of Sciences, Engineering, and Medicine issued a 110-page report outlining evidence-based recommendations for the reopening and operation of elementary and secondary schools. Overall, members of the committee tasked with reviewing the science concluded that decisions to reopen for in-person learning must balance the benefits and risks.

“We know there are serious consequences for not reopening schools for in-person learning,” Caitlin Rivers, senior scholar at the Johns Hopkins Center for Health Security in Baltimore and a committee member, pointed out during an August 12 webinar on the topic. Schools are more than a place for learning; they’re also where students access meals, medical and behavioral support, and other services, she noted. “But we also know there are serious risks associated with the pandemic.”

While recognizing that distance learning will play a huge role in the 2020-2021 academic year, the National Academies report acknowledges that children benefit socially, emotionally, and academically from in-person instruction. Being electronically tethered to teachers and classmates doesn’t provide the same level of personalized instruction and peer-to-peer interaction, among other benefits. The report points out that “some groups of students may be at greater risk of falling behind academically when distance learning is used for an extended period of time.”

If schools are able to reopen for in-person instruction, they should prioritize bringing back children in grades K-5 and students with special needs, the committee recommended. These children are less likely to benefit from remote learning and, given their social and emotional development, would be best served by returning to a school setting.

Kids and COVID-19—What are the health risks to children and their families?

Since the National Academies issued its report four weeks ago, a lot has changed. New studies have confirmed the extent to which children can be infected by COVID-19, while many states reported rising or stubbornly high numbers of coronavirus cases. “I think we have to take into consideration the fact that nationally, our outbreak is not in a good place,” said Rivers, expressing her personal opinion, not necessarily that of the committee.

While it’s true that children are less likely than adults to experience severe disease, they’re not invincible. Close to 180,000 new pediatric COVID-19 cases were reported in the US from July 9 through August 6, a 90% spike in just four weeks, according to AAP and the Children’s Hospital Association. Meanwhile, the number and rate of coronavirus cases in kids is “steadily increasing,” notes the CDC. As of August 15, children 17 and under accounted for 7.7% of all confirmed cases. One study found that kids likely carry the same or greater “viral load” as adults, and there’s evidence that they can effectively spread the infection to others, even if they don’t appear to be ill. That’s because as many as 45% of pediatric infections are asymptomatic, according to the CDC.

“We know that kids become infected; we know that they are capable of transmitting it to others,” says Josh Michaud, associate director for global heath policy at the Henry J. Kaiser Family Foundation. As for how much of a risk the school environment poses for viral transmission, “the evidence is more mixed and murky,” he tells Health. There haven’t been a lot of outbreaks at schools in Europe since they reopened, adds Michaud. But the US has far more cases overall. His report for Kaiser says the US has a test positivity rate above 8%, versus just 1.1% in France and 2.4% in Germany, for example.

How to reopen schools safely, according to science

First, local authorities must account for the level of SARS-CoV-2 (the virus that causes COVID-19) in the community, according to the CDC and others. Some places use cases per 100,000 population over the last seven days as a benchmark; others look at test positivity rates, meaning the number of coronavirus tests that come back positive divided by the number of tests performed. A rate above 10% likely means that a community doesn’t have a good grip on its local epidemic, says Michaud. Before schools consider opening up, a rate of below 5% is recommended. “School boards and decision-makers are using different criteria, and it’s a hodgepodge out there,” observes Michaud.

In hot spots where there is “substantial, uncontrolled transmission” that cannot be decreased, schools should put plans in place for virtual learning, per the CDC. But for those places where it’s considered safe to engage in some level of in-person instruction, the CDC, AAP, and others urge schools to adopt strategies to slow the spread of COVID-19 and mitigate the risk of transmission. These include:

Physical distancing. The goal should be for everyone to stay at least 6 feet apart, especially teachers and staff from children and other adults, says AAP. Spacing desks at least 3 feet apart may be beneficial as long as students avoid close contact, and especially if they’re symptom-free and wearing masks. When possible, the pediatrics group suggests using outdoor spaces for instruction and meals.

Face masks. With some exceptions, cloth face coverings “are strongly encouraged” for students, teachers, and staff, per the CDC. On Thursday, AAP issued guidance urging all children “with rare exception” to mask up. “As parents prepare to send their children to school and into childcare settings, cloth face coverings should be part of their new normal,” AAP President Sara “Sally” Goza, MD, said in a prepared statement.

Hand hygiene. Handwashing or using alcohol-based hand sanitizer is just as important in school as it is at home. The CDC encourages schools to set aside time for students, teachers, and staff to wash up, especially after bathroom breaks, before lunch, and after playing outside.

Cohorting. To reduce exposure to the coronavirus and prevent transmission, CDC says administrators should consider limiting contact among students and staff by creating smaller units. Limited evidence from other counties suggests such cohorts, pods, or bubbles may be a helpful mitigation tool. AAP guidelines identify cohorting as a “higher-priority” strategy for pre-K classes than face coverings, which may be difficult to implement.

Cleaning protocols. Schools that reopen require frequent cleaning and disinfection. The CDC says this includes frequently touched surfaces (such as door handles), shared objects (toys, computers, gym equipment), and surfaces soiled with blood or body fluids.

Schools that ignore the recommended guidelines for reopening are likely to see a spike in the infection rate, says AASA’s Domenech. “To go counter to the science is madness, and it’s a total disregard for the safety and welfare of students,” he says.

Should students and teachers be tested and screened?

“Testing all students for acute SARS-CoV-2 infection prior to the start of school is not feasible in most settings at this time,” says the AAP. However, per CDC guidelines, a student or staff member who has been exposed to the infection or has symptoms may need testing to determine next steps.

On the other hand, many universities, especially campuses that house and feed students, are employing COVID-19 testing and screening among other strategies to control outbreaks.

Researchers recently modeled what a coronavirus screening program might look like at a residential campus using different tests and varying testing frequencies. Bottom line: Symptom-based screening alone did not contain outbreaks under the various scenarios that researchers considered. To return students safely this fall at a reasonable cost, colleges would have to test students every 2 days at a cost of roughly $10 to $50 per test, they concluded. The study appears in the July 31 issue of JAMA Network Open.

A. David Paltiel, professor of health policy and management at Yale School of Public Health and one of the study’s authors, tells Health: “Most schools can’t reach the standard we suggest. It is too expensive and logically cumbersome, but just because it isn’t feasible doesn’t mean that it isn’t important.” He adds that a school relying on symptom-based screening is like “a fire department that only responds to calls after the house has burnt to the ground.”

What's the guidance on if there's an outbreak at school?

A single case doesn’t necessarily warrant a closure unless the virus spreads to other school community members, says Rivers, the Johns Hopkins epidemiologist. “What would raise my concern for a longer-term closure is if there is a change to the local burden of disease such that there’s a lot more virus circulating and it’s no longer safe to keep the school open.”

An isolated case can also serve as an example for the school community that kids can contract COVID-19, and taking precautions is important. Thompson, the Georgia mom, reports that her son came down with an upper respiratory infection, from which he’s “pretty much” recovered; nevertheless, his doctor advised that he stay home for 10 days. While mask-wearing at school is encouraged, it’s not required, so when someone at her son’s school tested positive, he was “a little freaked out,” says Thompson. “It was terrible that it happened, but I think it was a real eye opener for everyone else, because everyone started masking up.”

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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