July 20 — 4:09 pm, 2020

CHOP outlines safe conditions for reopening schools

Timely and equitable access to testing, masking, sanitizing, and social distancing are crucial, experts say. And national leaders must provide the necessary resources.

Meredith Matone, Deanna Marshall & David Rubin

St. Mary's Nursery School welcomes families back to a new normal after a three-month closure due to the coronavirus. (Photo: Bill Hangley)

Back in May, as our team of pediatric health experts at Children’s Hospital of Philadelphia drafted health and safety guidance for reopening schools, we felt optimistic. Cases were falling, and a quiet summer of COVID-19 felt possible — and for a brief moment, even likely.

What a difference eight weeks made. It is time to admit that with a runaway epidemic, which we project will only worsen, we are failing in our goal to protect schools. Despite the tireless planning that schools have done since spring, last week large districts in Phoenix, Atlanta, Los Angeles, and San Diego delayed in-person learning. In our city, the School District of Philadelphia announced a hybrid in-person/virtual learning model. The districts that have adopted these models aim to preserve student connectivity while upholding health and safety practices.

This week, however, Arlington, Va., reversed its plan for a hybrid model and announced that the school year would start with online learning. As we watch the dominoes fall, the decision for virtual reopening is as understandable as it is upsetting.

But especially in a month when school reopening became highly politicized, we should keep our eyes on the goal and strengthen our resolve to do right by children, families, and school staff by protecting the ability of schools to open safely, when the time is right, and remain open.

Schools hold unparalleled importance. In addition to education, schools keep children safe, provide health services, social development, physical activity, and nutrition — 30 million children in the United States rely on subsidized school meals, including three-quarters of Philadelphia’s students. Working parents depend on schools for child care, and community members use school programming and facilities. School closures have devastating effects on child health and family economic well-being, particularly for those living with the consequences of structural racism and income inequality who have limited access to broadband, food, and stable housing. We feel the urgency of school reopening deeply every day.

The truth is, there is no easy answer to the question of how to reopen schools. Pandemic decision-making is a frustrating process — a moving target informed by new science and resource realities. It is a risk assessment to be weighed against available and effective safety measures. We do know that there are foundational safety principles that will substantially reduce transmission risk when teachers and students are in the classroom. These should not be compromised despite the associated burden and cost.

First, safely reopening schools has always been tied to community transmission rates. Students and teachers have unavoidable social networks outside of school walls. Periods of high community infection rates present an increased risk within schools. This is because no safety protocol is airtight and particularly so in the context of schools, where we will be balancing the developmental needs of children with best practice in infection control. We should expect frequent falls off of that tightrope.

With new data suggesting that children play a role in spreading the virus, it is imperative that we reduce case counts before in-classroom learning begins. Guidance such as that issued by New York Gov. Andrew Cuomo, which ties school reopening to COVID-19 positivity rates within communities, is sound policy. The recent rise in COVID-19 cases within our Philadelphia community is cause for concern.

Second, when kids do return to the classroom, we must hold schools accountable to a simplified set of priorities for reducing transmission, including keeping symptomatic or exposed individuals out of school, physical distancing, masking, and hygiene. These priorities are reflected in the School District of Philadelphia’s 2020-2021 plan. Daily symptom and exposure screening with flexible sick policies for students and teachers are foundational to creating safe classrooms. We should not compromise the recommended six feet of distancing that children and teachers have within the classroom, even as we acknowledge the challenging space and staffing limitations that many districts face. Distancing recommendations are based on strong evidence for similar respiratory viruses. If these requirements cannot be met, then schools should consider flex scheduling — the significant logistical burden is worth it.

Masking has been the center of societal, and to a lesser extent, scientific controversy. However, four months into the pandemic, the data on the value of masks is becoming unassailable. Teachers need masks. Students need masks as much as we can practicably mask them — prioritizing drop-offs, hallway transitions, and bathroom times.

We also need frequent hygiene and disinfection to minimize transmission from touching surfaces, a topic overshadowed in the national debate about distancing and masking, but very salient to children.

To take these data-driven steps, schools need federal funding for the procurement of personal protective equipment and hygiene supplies now. Revised transportation protocols, classroom configurations, and flex virtual learning all require dollars.

Finally, working with public health departments and medical providers, schools need support in managing symptomatic and exposed children and teachers, as well as those with confirmed COVID-19 illness. While many local and state testing strategies have sensibly not prioritized children to date, as we move into fall, timely and equitable access to testing will be important. In the absence of targeted testing resources, it is hard to visualize a school year without unnecessary school closures, staffing shortages, and student absences.

We know from talking to numerous school districts in the Philadelphia area that schools are up to the challenge of planning for a safe return. Although the work ahead is daunting, their commitment to our children is unwavering. So, too, should our commitment be to supporting them. The value that our community has for schools will be reflected in the individual investments we make to urgently reduce case counts and risk for resurgence in our city — masking ourselves and keeping our networks small. And our societal value for schools will be reflected in the investment that our national leaders make to provide the necessary resources that will allow schools to open and remain open. The return on that investment is child and family well-being, which yields incredible dividends.

Meredith Matone, DrPH, MHS, is the scientific director of PolicyLab at Children’s Hospital of Philadelphia (CHOP). Deanna Marshall, MPH, is a clinical research coordinator at PolicyLab at CHOP. David Rubin, MD, MSCE, is the director of PolicyLab at CHOP.

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