Contact Tracing? Sports? Experts Explain School Reopening Research and Recommendations
It’s been a busy few months for schools reopening—and perhaps an even busier time for the agencies releasing guidance on how to do those reopenings safely. In February, the Centers for Disease Control and Prevention released its operational strategy guide for K-12 schools, a collection of prevention strategies and implementation tips for safe in-person learning.
That same month, the U.S. Department of Education launched the first volume of its COVID-19 handbook, which focuses on the parameters of school reopenings but also on equity concerns for reaching all learners.
And along the way, the CDC has issued a steady stream of Morbidity and Mortality Weekly Reports that distill the center’s research and field reports from working directly in schools.
While much of the guidance amounts to the same, it can all get a bit confusing. To help clarify things, two experts shared highlights, best practices and dos and don'ts at the recent National Safe School Reopening Summit. Hosted by the Department of Education’s Jessica Cardichon, the panel featured Greta Massetti, who leads a task force on community interventions and COVID-19 at the CDC, and Donna Harris-Aikens, senior advisor for policy and planning at the Department of Education.
What follows is a sampling of their remarks.
On how much physical distance is needed
“Over the last 12 months CDC has been very closely following the science and the studies that have been done in schools,” says Massetti, including three new studies released through the CDC”s MMWR last Friday. “Schools that have been doing full in-person instruction, many of them using less than six feet of physical distancing, were able to maintain low spread in schools.”
Recently, the CDC updated its guidance to say that only three feet of distancing is necessary in the classroom, but outside the classroom—particularly in common areas or whenever singing, shouting or physical activity is taking place—six feet is still the rule.
On COVID-19 testing and screening
“There’s two potential approaches to testing,” says Massetti. “The first is that we recommend that all schools should have a plan for diagnostic testing. What that means is all schools should know if someone has symptoms at school. It could be a teacher. It could be a staff member. It could be a student. And do they have a place they can refer the individual for testing? It could be that individual’s provider or a local public health clinic.
“There are many schools that also choose to implement screening testing. That is where there’s a regular plan for generally rapid diagnostic rapid screening for individuals. That could be a random sample of teachers and students. When prioritizing testing, we recommend that schools prioritize teachers and staff first, then high school and middle school students and then elementary school [students.]”
On contact tracing
“Open and ongoing communication with stakeholders is critical here,” says Harris-Aikens, “not just with your local health department and folks in the health community, but with educators inside your system and with families.
“If you have a plan that covers all sorts of conditions, contact tracing should be a part of that. Make sure that you’ve identified a person or people inside of every school who is responsible for the connections to contact tracing, and make sure that it’s part of the larger plan for the district and for the community.
“It’s all about making sure that those conversations happen upfront before there’s an incident, but certainly as people are working through ever-changing context and ever-changing health data.”
On improving ventilation
“Air exchange is essential,” says Massetti. “That’s what ventilation is all about. There are a variety of strategies that schools can use—oftentimes a combination [of strategies] is what’s needed to get that air change.
Strategies include bringing in outdoor air—which could mean cracking windows open whenever possible—and ensuring that HVAC systems are set to maximize ventilation. Facilities managers and experts in this area can help guide how to make those setting changes, increasing filtration and replacing filters.
“Use exhaust fans in restrooms and kitchens and put HEPA filters in classrooms. Think about all of the different ways to change that air flow within every classroom and every room in a building.”
On building hand-washing and respiratory etiquette into classroom routines
“I really recently saw a playlist that a music teacher put together for the length of time, about 20 seconds, for hand washing,” says Harris-Aikens, adding that it’s about “reinforcing those kinds of things throughout the day, whether it’s through the announcements in the morning or perhaps when students are going to lunch or from recess.
“Just as reminders, everyone [should] continue to have healthy hygiene behaviors, such as covering coughs and sneezes, washing hands after you blow your nose and making sure that there are adequate supplies in the school building,” including soap, tissues, masks, and hands-free trash cans with foot pedals. “Make sure that those are actually part of the system and not just something that an individual person has to remember.”
On creating school ‘bubbles’
“One thing I want to highlight is this best practice that’s emerging around use of cohorting,” Massati says. “It’s this idea that schools are creating bubbles. Some schools are creating bubbles around a particular classroom, and our MMWR article that was done in partnership with the Salt Lake County Schools did just that: They create cohorts for each classroom. In Wisconsin they used cohorts at the grade level. What that means is that there’s a smaller distance of less than six feet within those cohorts, but they use larger distances between cohorts. It allows them to keep spread low.”
On school staff vaccinations
“We definitely want to encourage all teachers, all educators, all school staff to access vaccination as soon as it is available to them,” says Massetti. “With March being educator vaccination month, we really are excited to see how many educators have been able to access vaccination. It’s great to see the numbers go up every day.
Later in the Summit, Education Secretary Miguel Cardona shared that 45 states have now prioritized educators for vaccinations, and in the last week alone, 500,000 educators had received a shot.
“Nonetheless, it’s only one component of effective prevention of COVID-19 in schools, and we really want to emphasize continuing to rely on those key prevention strategies. One of the reasons being that only people ages 16 and older can access vaccination; we don’t yet have an emergency-use approval for people younger than 16. So, at this time, we still encourage schools to use prevention, relying on universal masking, physical distancing and all of those key prevention strategies. And we know that when schools have been putting together that package of interventions, they've been able to safely provide in-person instruction in their buildings.”
On prioritizing equity
“First start with who will be most impacted by your decisions,” says Harris-Aikens. “Create equity checkpoints throughout your existing decision-making processes and start with the knowledge and belief that every child, every family, every educator brings assets to your school community. Make your decisions based on those facts.
“The voice of those most impacted needs to be at the decision-making tables. Is it students of color, students with disabilities, students experiencing homelessness, students without broadband access at home or the devices? Is it the paraprofessionals, is it the bus drivers, the school secretaries?
“Make decisions about who you’re prioritizing for in-person instruction. Who actually needs it first? If you haven’t already done it, make sure that equity is the first lens through which you view a challenge and that it serves as the foundation for those solutions. Because if it’s the last lens, it’s going to require you to retrofit equitable supports into solutions that you’ve already decided upon.”
On sports and extracurriculars
“There are ways to do things safely, even if you are following the CDC guidance, which we would highly recommend and stress,” says Harris-Aikens. “You can exercise outside, you can have band practice outside. Use the space in the auditorium, particularly in high schools, that may not be used during the school day, and spread students out so that you have space to do things where they don’t need to be as close. People just need to think about how to do things in a way that perhaps doesn't look familiar, but students and educators can still get the benefit of engaging in the activity, as long as they do it safely and follow the guidance.”
On additional safety measures
“Places like Denver are holding staff meetings virtually, so that they are limiting adult in-person interactions when they’re not specifically needed for instruction,” says Harris-Aikens. “In D.C. [Public Schools], they have a COVID Operations Handbook, that includes suggested classroom configurations, removing extra furniture, creating additional space from places in the school that are not needed for instruction.
“Make sure that there are things in collective bargaining agreements, like in Boston, that provide for masks with clear panels for speech therapy or working with students who are deaf or hard of hearing, or English learners or reading or other oral language classes. It all comes from open and honest conversations and making sure that collaboration is actually highlighted.”