The finding offered this week by researchers from the U.S. Centers for Disease Control and Prevention that schools have not been hotbeds of rapid on-campus transmission of COVID-19 or even of significant student-to-staff infection grabbed headlines and raised hope that we can get children back in class soon—a goal we as pediatricians share. While the poet Gertrude Stein famously wrote, “A rose is a rose is a rose,” we need to be clear as a nation that when it comes to reopening schools safely, that safe is not safe is not safe.
The ABC Science Collaborative we lead (and whose research the CDC cited) has partnered with nearly 50 school districts in North Carolina to help educators and families understand the most current and relevant data about COVID-19 so that they may make decisions that will keep teachers, staff, and children safe when they return to the classroom.
First and foremost, no school can be called safe without following what North Carolina calls “the 3Ws"—wear a mask, wait at [a safe] distance, and wash hands. Beyond that, with our school partners, we have determined 12 principles that define safe school reopening during this pandemic:
- Be transparent. Schools should report all COVID-19 cases weekly. We know that schools are rarely super-spreaders and that infection rates in schools are reflective of infection rates in communities—not vice versa. Reporting cases makes this fact clear.
- Make a road map for contact tracing and testing. School districts and health departments should make these road maps available to the public in writing to describe exactly who will do what for successful contact tracing. This should include timing and the details of how tracing happens and highlight the differences for how this is done for young children (who may not have effective verbal communication) as well as adults.
- Develop a dashboard. Districts should have a way to see and use school-level data in making decisions. Dashboards should be school-specific (for principals and vice principals) and districtwide (available for superintendents and other district leaders). These dashboards should include numbers available to the public such as cases, information specifically for school leaders on within-school transmission rates, number of staff and students in quarantine, testing rates, vaccination status, and comparisons of this information with countywide data.
Simply calling school reopening 'safe' in a public meeting or on a website does not make it so.
- Work with a trusted third party to analyze data. Many districts lack the expertise to analyze secondary transmission rates adjusted for population as well as other concerns related to emerging science, virology, and epidemiology. A third party, such as a university or nonprofit, also can act as a clearinghouse for knowledge management across districts in a region or state.
- Leverage up-to-date metrics. The experience in North Carolina, Mississippi, Wisconsin, Western Europe, Asia, and Australia gives us insights into how much COVID-19 “spread” to expect in schools that adhere to masking, physical distancing, and handwashing, including metrics such as secondary transmission per 10,000 students. These metrics are preferable to county data because the crucial element of managing schools is to prevent spread within schools. The details of these metrics for considering when to move from in-person to remote instruction can vary by district, and the precision of these metrics will improve as we gather more data.
- Develop a plan for clear communications. Before providing face-to-face instruction, districts should have in place a detailed plan for communicating about cases and within-school transmissions if they occur.
- Be precise. The details of how students, staff, and visitors will adhere to the 3Ws for the entire school day should be clear to all and can be customized for each school, depending on the age of students and their ability to follow the guidance. ABC has models for elementary, middle, and high schools.
- Consider special-needs settings. These teachers and students need additional precautions. Plans should be developed locally, and these school communities should receive allocation of extra resources as masking is not always possible. These could include additional personal protective equipment (or PPE), flexible hours, additional face shields, and creative approaches to ventilation and airflow.
- Consider extracurriculars. Activities including sports, the arts, and other school-sponsored activities need their own detailed plans for masking, physical distancing, and handwashing. CDC’s researchers noted the increased risk of transmission associated with these activities.
- Walk, then run. Starting back to in-person learning slowly (for example, in a hybrid model) can give everyone a chance to adapt to the new procedures and policies.
- Implement lessons learned. Whenever there is a cluster or secondary transmission, school leaders should work with school staff to understand the event and to implement lessons learned.
- Acknowledge pandemic fatigue but stay adherent. Pandemic fatigue is real, but so are data that show that we should target more than 99 percent adherence to masking by students, teachers, and staff on school property at all times (except for eating and drinking) to be safe. “I wear a mask to protect you; you wear a mask to protect me,” is something that can resonate with even the youngest students. Implement strategies to ensure long-term adherence to mask compliance, distancing, and hand hygiene that can include a hot line or web portal to report non-compliance or daily walk-throughs.
The translation of our state motto is “to be rather than to seem.” Simply calling school reopening “safe” in a public meeting or on a website does not make it so. Taking a set of evidence-based steps before reopening schools and following through diligently and routinely once they are open will make classrooms and campuses safe again for students and staff.
