To reopen schools in the fall as safely as possible, communities need to suppress the spread of COVID-19 this summer while preparing a rigorous public health response to outbreak flares, public health and education experts said in a commentary published yesterday in JAMA.
Joshua Sharfstein, MD, and Christopher Morphew, PhD, of Johns Hopkins University in Baltimore, said that while it's unclear whether school closures this spring tamped demand for hospital beds, it is clear that they harmed many of the 55 million kids missing months of in-person education and the other benefits it entails.
When schools close, children's access to school-based food, health services, counseling, and social services is cut off. Also, many families lack home computers and internet service, which form the basis of distance learning. The effects will likely be most profound among students already at risk, those with learning disabilities, and those subject to abuse and neglect, the authors said.
For these reasons, schools must reopen in the fall—even if it involves hybrid online and in-person instruction or sporadic returns to an all-remote format, they said, offering a six-part framework to do it safely and lower the risk of having to close again because of another pandemic wave in the fall or winter.
Yet they emphasized that opening schools is not without risk, particularly with reports of an uncommon but serious pediatric multisystem inflammatory syndrome associated with COVID-19.
"The best way to avoid a replay of the widespread closures is to control the pandemic more effectively in the future," they wrote. "Every community should implement a rigorous program of testing, contact tracing, isolation, and quarantine."
More money for school preparedness
The guidelines say that schools should create evidence-based plans with input from parents, teachers, unions, school health experts, and students that include family support, regular outreach, and additional counselors, social workers, and nurses.
They called for Congress to provide billions of dollars to fund these measures, particularly for schools with many children who receive free or reduced lunches and special education services.
The government, the authors said, should also fund research to inform the care of children with respiratory disease and COVID-19–related multisystem inflammatory syndrome, determine the extent of virus transmission in schools, evaluate the effects of distance learning and school closures on community transmission, and identify the most effective education designs and infection-control measures.
"An advisory body with representation from the medical, public health, ethics, and educational communities should summarize the results of this research and its implications for practice on a regular basis," they wrote.
The school day, transformed
Schools should enforce social distancing—even in communities with low levels of spread. They call for placing desks 6 feet apart, keeping groups of children together throughout the day to minimize mixing, staggering drop-off and pick-up times, closing common spaces, adding more buses or other modes of transport, restricting nonessential visits, canceling extracurricular activities that involve close contact, and requiring staff and students to wear face masks.
If strategies involve alternating morning, afternoon, daily, or weekly schedules, the guidelines say that students with barriers to distance learning, those who receive special education or nutrition services, and those who are younger should be given priority for in-person instruction. And districts and schools with high numbers of these students should be given assistance to create more space and increase staffing and access to technology.
Each day before school, parents should be required to complete a checklist documenting that their children are symptom-free and that all other family members are healthy. And when students arrive at school, nursing aides or other trained staff should screen children for signs of illness.
Schools should supply handwashing and other disinfection supplies, regularly disinfect frequently touched surfaces and classrooms, and provide adequate personal protective equipment to staff. Students with symptoms should be promptly tested and sent home for isolation and quarantine if they are positive for the coronavirus, in addition to notification of public health officials, further testing of classmates and staff, and more school cleaning.
Urgency, vigilance, lingering effects
Schools must actively survey for children with signs or symptoms of the inflammatory illness affecting some young COVID-19 patients and respond accordingly. And parents should be told that attending school is not risk-free. "It will not be possible to reduce the risk of COVID-19 transmission in schools to zero," the authors wrote.
If teachers are reluctant to return to school or families with members at high risk for COVID-19 complications are unwilling to send their children, schools should identify and train teachers at high risk in distance-learning best practices over the summer so other teachers and students could participate in case of home quarantine or school closures, the authors said.
They called the coronavirus pandemic a long-term threat to national health. "Through its effects on children, the legacy of COVID-19 will last for years," the authors wrote. "The urgency and challenge of reopening schools requires the nation's full attention today."