Reopening schools during a pandemic has brought to light a unique set of concerns related to the risk of transmission and infection among students and staff, and everyone with whom they come into contact. In this article, we offer tips for parents, school administrators, teachers, and onsite staff based on current guidelines and recommendations to reopening K-12 schools issued by leading academic, healthcare, and government organizations. We also share some lessons learned from countries that have reopened schools without experiencing significant outbreaks.
Why Reopen Schools?
There are many factors that make it hard for schools to control the potential spread of viruses such as Covid-19. Schools are often crowded; facilities and resources such as bathrooms, books, and desk space are shared by large groups of people; and young children are more likely to engage in behaviors that are associated with the risk of viral transmission, such as lack of (or improper) handwashing and tendency to play in close proximity to others.
So why push to reopen schools at all during an ongoing pandemic? For one thing, in-person learning is critical to the psychosocial and educational development of children K-12. A Stanford University study concluded that full-time online instruction was, overall, less effective and less accessible than in-person schooling. In addition to academic instruction, schools also offer a platform for social interaction where children learn to manage their emotions, establish and maintain positive relationships, make responsible decisions, and develop crucial communication skills. These interactions are very difficult to replicate through distance learning.
Schools can also provide critical access to resources such as reliable meals, medical aid, and social, behavioral, and mental health services. Disrupting access to these services can incur long-term individual and societal costs. School closures disproportionately impact marginalized communities, the same communities who also bear the brunt of the Covid-19 pandemic. These communities not only rely more heavily on the aforementioned resources provided in schools, but are also less likely to have access to reliable internet and/or digital technology such as laptops, further exacerbating educational disparities. Finally, schools can provide employment for onsite staff such as custodial workers, lunch staff, and school nurses, in addition to much needed childcare support for working parents, guardians, and caretakers (particularly for those who are essential workers).
Given the important role that schools play in our society, both the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend prioritizing reopening schools, and underscore that school districts must take into consideration the racial, economic, and social implications that accompany school closures. It is important to preface that not all schools should be candidates for reopening. The American Federation of Teachers maintains that schools should only consider reopening when fewer than 5% of coronavirus tests in a community are positive, and the transmission rate is below 1%. Studies conducted in South Korea, Australia, and Europe have shown that schools are able to reopen with little to no new outbreaks – but only when community transmission is low.
Addressing Common Misconceptions
Due to our rapidly evolving research and understanding of Covid-19, there are some understandable discrepancies in information surrounding children’s risk and school reopening policies. Below we address some of these concerns.
How Likely Are Children to Get and/or Transmit Covid-19?
One common misconception is that children are immune to Covid-19 and thus cannot transmit the virus. There is currently no evidence confirming that children are unable to be infected with and/or transmit Covid-19. Existing data does suggest that children (aged 0 to 17) have a lower infection rate, in addition to presenting with milder symptoms and having lower mortality rates, when compared with adults (aged 18+). However, new evidence suggests that the age of 10 years may serve as an important turning point after which risk increases. An Icelandic study found that children under the age of 10 were less likely to test positive for Covid-19, compared to children over the age of 10.
Children’s likelihood of transmitting the virus to others is not yet well understood. Emerging evidence indicates that infected children and young adults (aged 0 to 22) have significantly greater viral loads compared to hospitalized adults (aged 23+) in Covid-19 ICUs, despite exhibiting mild to no symptoms. (While the association between viral load and infectivity also remains unclear, a high viral load close to symptom onset may be associated with an increased risk of transmission.) Children are thus considered potential “silent spreaders.” However, other evidence suggests that children younger than 10 may be less likely to transmit the virus. For example, a South Korean study found that children younger than 10 years of age were less likely to transmit Covid-19 compared to adults, while children who are older may transmit at levels similar to adults.
Regardless of the likelihood of infection or transmission, any amount of risk must be taken seriously. While rare, multisystem inflammatory syndrome (MIS-C) has been associated with children infected with Covid-19 and may result in serious and life-threatening illness. The World Health Organization (WHO) continues to recommend that people of all ages take precautions to protect themselves from Covid-19.
Should Young Children Wear Masks?
Another widely circulating misconception is that masks may be harmful to young children. The CDC currently recommends that children 2 years of age and older wear cloth face coverings, particularly in settings where social distancing may be difficult. However, face coverings are not recommended for children who have trouble breathing or are incapacitated/unable to remove their face coverings without assistance. Parents of children with special health considerations should consult with a medical professional for further guidance.
Preparing for In-Person Instruction During the Pandemic
While there is no such thing as zero risk, following guidelines and recommended practices can help lower the risk of outbreaks within schools, including to understand and adhere to your school’s particular policies.
Wear Your Mask (Face Covering).
Scientific evidence shows that wearing a face covering significantly reduces Covid-19 infections, offering protection against both respiratory droplets and airborne transmission. The CDC recommends that schools enforce consistent masking policies for both students and staff.
Teachers and staff who engage with students who are deaf or hard of hearing, English language learners, and/or those who rely on facial cues and expressions, may opt to wear clear face coverings.
School administrators should also educate students and staff on face covering techniques and hygiene, such as avoiding touching the face covering before washing or sanitizing hands. Furthermore, reusable face coverings should be washed after every day of use; students and staff may consider purchasing several reusable face coverings to rotate throughout the week. It is also important to ensure that your face covering fits; face coverings should cover the nose and mouth, with no gaps.
Schools with younger children may consider encouraging outdoor recess or structured “mask breaks,” as adherence to masking may be more difficult for young children.
Know When to Stay Home.
Students and staff should monitor their symptoms and temperature daily. If possible, take your temperature at home prior to going to school each morning. Those with symptoms are advised to stay home and get tested and/or medically evaluated. Students or staff who test positive for Covid-19 should contact the school and appropriate public health authorities. This is general guidance, and it is important to follow any additional or alternative specific policies at your school regarding possible Covid-19 infection or exposure.
School administrators should collaborate closely with their local health departments, notifying them of any confirmed Covid-19 cases, and require anyone with symptoms to self-isolate for at least the recommended timeline set by the CDC after symptom onset, waiting until at least 24 hours with no fever without fever-reducing medication and improvement of symptoms before returning to school. Schools should also require students who have been in close contact with a confirmed case of Covid-19 to self-isolate. School administrators may consider following in the footsteps of Germany and Vietnam, where widespread coronavirus testing and mandatory temperature checks are being employed in schools.
Maintain Social Distancing.
Social (physical) distancing is fundamental to mitigating transmission of Covid-19. While it is recommended that students stay at least 6 feet apart, this recommendation may not always be feasible due to limited space. With this in mind, the AAP recommends that schools place desks at least 3 feet apart, though 6 feet is ideal.
When possible, the CDC strongly encourages school administrators to consider cohorting, whereby students (and sometimes staff) limit physical proximity to others within a specific group. This decreases opportunities for exposure and transmission by reducing contact with other individuals and shared objects and surfaces.
School administrators may also opt to reduce movement and over-crowding by staggering lunches, break times, and arrival and dismissal times. Administrators also may consider limiting non-essential visitors. In Japan for example, students were instructed to eat at their desks, rather than crowding in cafeterias with a density of mask-less students. If this is not possible, schools may consider moving lunch settings to other areas of the school or outside, in order to accommodate students and staff while reducing crowds.
School administrators may also choose to implement a staggered re-entry approach, in which younger children and/or students who would be most adversely affected by remote learning, such as low income students and students with disabilities, return first. For example, the Netherlands and Denmark took a staggered re-entry approach in which kindergarten and elementary school students were the first to return to school in order to alleviate the burden of childcare on working parents. After a month, children over the age of 12 were reintegrated into the system.
When possible, schools should move lessons and recess outdoors – to avoid crowding indoors and to better enforce social distancing, particularly among young children. In Denmark, which re-opened schools in the spring, community parks were reserved during school hours for outdoor lessons, educational activities, and play.
Sanitize Surfaces and Spaces.
While the WHO and CDC currently maintain that Covid-19 is primarily spread through person-to-person interaction via droplet transmission, surface transmission may also occur. Thus, effective sanitization and disinfection practices must not be neglected.
School administrators should continually reinforce verbal, visual, and auditory reminders for students and staff to wash their hands. Schools can also implement a handwashing schedule. For example, in Denmark, children are required to wash their hands every two hours.
High-touch surfaces, such as desks, door handles, railings, toys and playground equipment should be sanitized and disinfected frequently. If possible, schools should use disinfectant products that are both safe for people and the environment. Schools should also ensure that students and staff, with the exception of staff tasked with disinfecting these facilities, are not present during disinfection. If that isn’t possible, adequate ventilation should be in place (natural or mechanical) to reduce chemical exposure.
Enhance Indoor Air Quality.
Because SARS-CoV-2 can remain in the air for hours, experts from the Harvard T.H Chan School of Public Health recommend that schools eliminate or minimize indoor air recirculation and maximize fresh outdoor air intake as much as possible. Adequate ventilation helps to dilute infectious airborne viral particles, while air filtration works to capture and remove particles that may carry viruses from the air.
School administrators should work with facility managers and outside professionals to tailor strategies for ventilation, filtration, and supplemental air cleaning, based on their unique building systems. In fact, Delos has partnered with the New York City Department of Education to dispatch 10,000 standalone air purifiers to public schools across the city to help mitigate risk of Covid-19 transmission within schools.
Schools with HVAC systems should switch to outdoor air intake only, while schools that rely on natural ventilation are encouraged to open windows and use window fans to promote airflow. ASHRAE, the American Society of Heating, Refrigerating and Air-Conditioning Engineers, recommends that schools use filters with MERV 13 or higher ratings, or high efficiency particulate air (HEPA) filters. More advanced air quality techniques, such as ultraviolet germicidal irradiation (UVGI) and maintaining an indoor relative humidity between 40-60%, may also be considered as recommended by technical experts.
Mitigate Risk on Your Way to School.
School buses tend to have poor ventilation, limited space, and long routes — all of which are risk factors for the spread of Covid-19.
If possible, both students, teachers, and onsite staff should drive, bike, or walk to school. These alternatives not only help to reduce the risk of infection, but also limit capacity on school buses for students who have no other option. It is recommended that schools limit bus capacity to 50% to help ensure social distancing, and enforce mandatory masking policies. When possible, bus drivers should keep windows open to improve ventilation. Students should also sanitize their hands prior to boarding and again when disembarking.
Do Not Neglect Immunizations.
Since the beginning of the pandemic, routine childhood immunizations have dropped significantly, due largely to canceled or postponed pediatric checkups. Despite the ongoing pandemic, existing immunizations should not be deferred – it is critical for parents to continue to protect their child against outbreaks of vaccine preventable illnesses.
Furthermore, as we prepare for the confluence of the flu, Covid-19, and school reopening, the AAP highly recommends influenza vaccinations for all students and staff.
Focus on What You Can Control.
Returning to school during a pandemic can be stressful for children, staff, and their families. To help reduce stress and anxiety, focus on what is within your control. Practicing hygiene and mask wearing at home and enforcing daily routines may help parents and children feel more confident when returning to school.
School administrations should work together with their staff to address outstanding concerns. When reopening, the Danish Government, health authorities, and school administrators held discussions with the Danish Union of Teachers in order to address the concerns of teachers. Because teachers are often the main enforcers of school policies, parents and caregivers felt more comfortable with the return to school plan knowing that teachers were confident in the safeguards.
Recognizing the influential role of teachers in communicating science-backed health and safety recommendations produced in response to the COVID-19 pandemic, IWBI launched the COVID-19 Teacher Training, a self-guided course containing actionable strategies to help teachers navigate changes to the learning environment.
Finally, school administrators can help foster mental wellbeing by providing counseling options for returning students, teachers, and onsite staff, with a focus on stress management and mindfulness modalities.