COVID-19: A Doctor’s Take On Five Ways Schools Can Keep Your Kids Safe

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School usually starts after summer’s last hurrah of Labor Day. But this back-to-school-year will be unlike any other as the coronavirus pandemic and the threat of a second wave loom ahead the school season.

According to an Associated Press/NORC poll released July 22, only 8% of Americans said they believed K-12 schools should open as usual and only 14% thought schools needed minor adjustments. On the other hand, 46% said schools should only open with major adjustments and 31% said they didn’t think schools should open at all.

The large number of respondents – 77% of whom believe big changes are needed in how children should be educated this year – is reflective of fears that schools and local health officials may not be well-resourced enough and/or working quickly enough to put a plan in place that could prevent schools from becoming the source of major coronavirus outbreaks.

Reopening schools will involve rethinking classrooms and classroom sizes, sports, buses and a whole host of other important factors; groups with expertise, such as the Centers for Disease Control and Prevention as well as the American Academy of Pediatrics, have already released guidelines for school reopenings. To assess what policies to look for in your school that offer students and school staff the lowest risk of transmission, Heavy spoke with Dr. Silvia Chiang, assistant professor of Pediatrics at Brown University’s Warren Alpert Medical School and attending physician at Hasbro Children’s Hospital’s Pediatric Infectious Diseases ward.

Here’s what she said:

1. Schools Should Be Following CDC Guidelines

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Chiang said there is no substitute for doing the things that the CDC is advising everyone else to do, which include proper handwashing, social distancing, wearing a mask and avoiding touching one’s face. The complete list can be found here.

“Teachers and students, middle and high school students, should be wearing masks,” she said.

She also acknowledged that it might be more difficult to enforce, especially among young children, but she also said that there are ways to encourage cooperation. “I think that young children are quite teachable, they really want to learn and they’re very eager to please. Of course, they have less self-control. It is really hard to have young children not touch their face.”

Moreover, she said it helps protect others from those who may be asymptomatic or believe their mild symptoms are signs of something such as allergies: “The younger you are,” she said, “the more likely you are to have mild symptoms or no symptoms.”

2. Distancing And Separation Will Make Contact Tracing Easier

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Students should be socially distanced in classrooms, Chiang said. “Should students sit six feet apart? Ideally, yes. There are a lot of limitations to it, but yes. Sitting even just three feet apart affords more protection than sitting close together, but six feet is still better.”

Another recommendation, Chiang said, involves keeping teachers and students in groups all day, so that if one person in the group gets sick, the contact tracing process is much easier.

“Again, if you keep those fixed small groups (and) you find that a student is infected, you don’t have to shut down a school,” she explained. “You can isolate those students. But if you have a school where everybody is mingling, that can be very challenging and you may have to close down the school.”

Contact tracing, Chiang said, is what will help health officials contain individual cases and prevent schools from being sources of outbreaks.

3. Good Ventilation May Help Disperse Droplets

The CDC has encouraged buildings to increase how much outdoor air is used and to use natural ventilation whenever possible. “Increase the percentage of outdoor air, (e.g., using economizer modes of HVAC operations) potentially as high as 100%,” the CDC encourages. “Consider using natural ventilation (i.e., opening windows if possible and safe to do so) to increase outdoor air dilution of indoor air when environmental conditions and building requirements allow.”

The Environmental Protection Agency (EPA) also acknowledged that more research has indicated “this virus can remain airborne for longer times and further distances than originally thought” which means “close contact with infected people and contaminated surfaces” are not the only ways someone could become infected.

Chiang said it’s more of a nuanced issue than many people believe and explained that even if a disease that may be able to be transmitted through aerosols may not be as contagious as other diseases that primarily rely on that method of transmission:

There’s still a lot of unknowns with this particular part of (airborne) transmission. In infectious diseases, there are people who have specific expertise in infection control, I am not one of them. There has been a lot of news coverage about the airborne vs. droplets issue. My impression is that sometimes when people think about the airborne vs. droplet issue, they think about it as an either/or choice, but it’s more of a gradient. SARS-CoV-2 can be transmitted through aerosols, such as during certain medical procedures. However, based on my conversations with infection control experts, it’s probably not a huge contributor.

The main transmission mode is likely large droplets. When you’re talking about a pathogen that is spread primarily through aerosols, the first disease that comes to mind is measles. If SARS-CoV-2 were transmitted like measles, you would expect to see a much faster and a much higher rate of transmission. I don’t think that most scientists ever doubted that SARS-CoV-2 could be transmitted through aerosols under certain circumstances, but the main question is under what circumstances and how often does airborne transmission contributes to community spread. If schools could have classes outdoors and with the open air and air currents, it’s easier for droplets to disperse. I think that if you are in a place with poor ventilation … yes, it may make the likelihood of transmission higher, but we’re still figuring out by how much.

4. Regular Testing & Screening Are Needed

Chiang also noted that schools, as many did before closing for the year, should be checking all students every day for symptoms. Those measures include checking temperatures and immediately removing students who show symptoms and/or alert staff that they feel ill.

Chiang said that Brown University, where she works, has a reopening plan that includes requiring tests of students and staff, which will also help with contact tracing and hopefully, prevent individual cases from becoming outbreaks.

I think if you were able to get enough resources, you could (test) asymptomatic students and the staff to monitor viral transmission in the schools; that would be great. It doesn’t seem like kids younger than ten years spread the virus as much as adults, but this conclusion is very, very preliminary, and we need more studies to clarify this issue.

5. Reducing the Movement Of Large Groups Lowers the Risk of Transmission

Chiang said noted that schools may also have to rethink transportation both in how students get from one class to the next as well as how students get to school in the first place.

For school buses, Chiang said, things may need to be adjusted: “It would be ideal for students to avoid the bus, but what if families don’t have a private car or they can’t walk?; I think for parents that have low SES, it’s particularly challenging.”

In schools, Chiang said, the transition between classes might need to change.

In middle and high schools, students switch classes. They go to their lockers and they’re crammed into small hallways, and I think that’s something that schools are going to have to think about. One solution is to have the students stay in their classrooms and have the teachers move around. Other things to think about are teachers’ lounges; schools are going to have to think about how best to prevent transmission there. Other things, limiting visitors into the school.

Schools in general, Chiang explained, are locations where there’s a higher risk of transmission because there’s very little opportunity to socially distance without decreasing the number of students allowed in that space.

A school is a place where a lot of people are going to come around each other. We’re probably going to find that adolescents can transmit as well as adults. But once again, that depends on resources. If you have a family with a high SES and well-educated parents who are able to help with homework and meals and have a stable internet connection, you might be able to do that. But what if families don’t have a private car or they can’t walk; I think for parents that have low SES, it’s particularly challenging. If you have parents with a low SES, if you have parents who work full-time or have two jobs and maybe they can’t help with homework as much or maybe they have to rely on school for food, that’s a tough situation; I think school is really, really important and perhaps more important for kids in that situation. There’s going to have to be very careful considerations of risk-benefit.

There’s definitely a lot to think about in terms of reopening schools and it will likely be a tricky balancing act, healthwise, resource-wise, socially and politically. School districts will have to consider the level of community spread in their area and what reopening schools could mean for that level and parents/guardians of school-age children will ultimately have to make the decision of whether schools are safe enough for their children and everyone else in the household.

Chiang said it’s best to think of school reopening as part of a larger, more comprehensive plan where prioritization is key.

“I honestly think that the things we talked about – the distancing, mask-wearing, washing hands, trying not to touch their face, staying in small and stable, doing sports that are lower-risk – I think those things are going to be the most important ways to prevent transmission of the coronavirus,” she said. “I don’t think anybody would argue education is not important. We should really think about what we prioritize as a society. A friend of mine is an epidemiologist, Helen Jenkins. She and her husband, who is also an epidemiologist, published an op-ed in the Washington Post where they recommended reframing the issue of school reopening. Reopening schools should be part of a comprehensive reopening plan and should be prioritized over other sectors, such as bars. If we want to send our kids to school safely, maybe we need to rethink what part of our society we prioritize reopening.”

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