For safety’s sake, if schools must reopen, do the following at a minimum

Gerard Bossard is a public high school teacher and freelance writer. Douglas Rothman is a professor of Radiology and Biomedical Engineering at Yale University. He is performing research on COVID-19.

Recently we published an article designed for parents and educators entitled, “2020 School Year: The Most Dangerous COVID Spreader of All.” In it, we predicted that schools would form an ideal environment for the virus to spread. Therefore, opening schools to in-person learning before the transmission and severity of COVID-19 have been greatly mitigated by vaccine and/or treatments is extremely dangerous and will assuredly result in the spreading of coronavirus — not only to the people in the schools that open, but to the people in the homes and communities connected to those schools.

Since our article’s publication, the large number of COVID-19 outbreaks associated with school reopenings have shown our concerns, sadly, were well-founded. This essay, then, is designed specifically for educators, so you may keep your students, your staff, yourselves and your communities safe.

An effective idea from our first article is especially relevant here: Middle and high school students can be safely taught at home through virtual instruction, and the vacated middle schools and high schools can then be used for younger children so they are safely socially distancedThose vacated middle and high schools would also be available for older students who might require a monitored environment or are unable to access virtual learning.

If this idea is not implemented, then based on what is known about COVID-19 viral spread, the following recommendations are essential for maintaining a safe learning environment.   

First, start with the facts. Schools are the ideal environment for spreading COVID-19. Studies have shown children can catch and spread COVID-19 as easily as adults. Children of all ages, once infected, can carry high viral, contagious loads, which they can pass on to their parents and others.

Symptom monitoring is an ineffective strategy for identifying infected children, because nearly 50% of children do not exhibit symptoms. Although COVID-19 is rarely lethal for children, as many as 1 out of 11 children who develop symptoms are hospitalized, and 1 out of 3 of those become sick enough to require ICU treatment. Children can also develop severe illness during the post-infectious stage with a hyper-inflammatory antibody response.

If schools were to reopen without necessary precautions, it is highly likely children would play a much larger role in this pandemic than has occurred previously.

Second, everyone needs to know the basics. The school community — students, parents, all school staff and all people in the communities these groups are connected to  need basic information on COVID-19 transmission and how to reduce it through established procedures.

This is not a normal time: In the context of a deadly virus, one person who does not know vital facts can become infected and bring COVID to an entire school and, thereby, to an entire community. We cannot let that happen, so in addition to multiple, mandatory information sessions for ALL the school’s constituents, the highlights of all the vital information must be posted nearly everywhere  in schools and in their respective communities  and everyone needs to sign agreements that say they understand and will abide by all the regulations.

Some of the vital information that everyone must know is how the virus is spread, what the most dangerous situations are and how to avoid them. As for spread  it’s human to human contact, whether people are in the presence of each other or leave remnants of themselves by touching objects or having talked, eaten or simply breathed in an area in which others congregate or pass. The physical situations include any area where two or more people can pass through or meet.

As they pertain to schools, these areas include the homes of students, educators and school staff, and all the places in the community to which these school-related people travel. These places include stores, banks, gas stations, cars, buses, bus stops, cafeterias, hallways, classrooms, lockers, gymnasiums, locker rooms, all bathrooms and more.

And, as has been well-documented and discussed, everyone must wear a mask outside of a completely safe environment, wash hands frequently and safely socially distance.

Third, staggered attendance is key. In order to meet social distancing and other sanitary requirements, students’ attendance in school will need to be staggered so the fewest number of students at a time will be present. In addition, a full online option needs to be offered to all students whose families do not want to take the risks associated with their children attending class in-person. This option will also reduce student density in school buildings.

Fourth, only locales with low case rates should reopen. School openings should only be considered in counties with a low number of infected individuals as determined by testing, referred to as green areas. And even in these regions, students, educators and staff must be tested every two days with results within 12-24 hours to ensure there is minimal spread from infected individuals who enter the school.

If anyone tests positive, he or she must immediately be quarantined for a minimum of 14 days, at the end of which they are retested. Furthermore, contact tracing within and outside of the school must be done and appropriate testing and quarantine measures applied.

Regarding the specific procedures all schools must employ, we found it clearer to provide a bulleted list. We break them up into general procedures and education, specific mitigation procedures, and testing and quarantine. More comprehensive descriptions and explanations are found on the CDC website.

Ours is an extraordinary time  one that demands our knowledge of and respect for facts, clarity of communication and unity of purpose. And our purpose is clear: to save as many lives as possible. We hope you will join us in this endeavor by applying the facts and procedures illustrated below.

General procedures and education                                                                             

  • Students, teachers, administrators and staff undergo required online learning, ideally with a test component, on the risks of COVID-19 spread and the proper behavior that mitigates these risks. (e.g. hand-washing, distancing, sanitizing, etc.)

  • Parents take a shortened version of the above so they understand and support the procedures being implemented.

  • Students, teachers, administrators and staff undergo required online learning that covers the specific protocols for those times they are on a school campus. (e.g. how to transition between classes, how and when to clean each classroom in between classes, and by whom those rooms will be cleaned, etc.)  

  • Feedback and performance review mechanisms need to be in place to ensure plans are followed and remediation mechanisms are employed where necessary.

Specific transmission mitigation procedures

Below are some of the specific measures we believe are the most critical. The list is not exhaustive, however, and we highly recommend reviewing guidance from the CDC as well as state departments of health in designing and implementing plans.  

  • Personal protective and sanitary equipment (masks, gloves, eye/face protection, hand sanitizer) abundantly available in all rooms.

  • Signs in all rooms and hallways describing specific procedures to be followed. (e.g. proper hand-washing and number of students allowed at a time in bathrooms, etc.) 

  • Masks, goggles or visors worn at all times, as the virus can enter through the eye sockets.

  • No common use of any objects. (e.g. computers, phones, books, pencils, pens, door knobs, water fountains, faucets, etc.)

  • All doors left open  including bathrooms.

  • Universally understood: proper hand-washing, mask-wearing, distancing, no touching.

  • A specific plan for staggering class transitions and movements in hallways, and other areas of the school.

  • Desks in classrooms blocked off so seating is six feet apart in all directions.

  • Large, open areas (e.g basketball court but not the bleachers, cafeteria with no tables) used for student lunches. Spaces for students marked with six foot minimum separation in all directions and all areas sanitized thoroughly prior to the first session and before each following session.

  • Classrooms given one hour to be sanitized after occupancy (and to allow air to circulate several times) between each period. This means time-staggering room use.

  • Air should have several turnovers per hour and windows kept open whenever possible.

  • Air should be HEPA filtered and UV sterilized.

Transportation to and from school campus

  • The same social distancing, mask-wearing, no touching applies everywhere  at the bus stop, on route to the bus stop, from the bus stop to home, in the bus, in the car and in all areas where students wait to enter school.

  • Outside is the best place for the waiting area, but if inside is necessary, then large spaces (cafeteria, gymnasium) with designated social distancing are required.

  • All these spaces must be immediately and thoroughly disinfected after students and staff leave them.

  • No car pooling. 

  • In buses, of course, social distancing must occur, as well. The seating must not only be six feet apart, but must be arranged diagonally so the first student sits in the first seat on the right side (because the driver is on the left side) that is a minimum of six feet from the driver. The second student will sit in the first seat on the left side that is six feet from the first student, and so on. Buses are also immediately and entirely disinfected and aired out after use.

Testing, quarantine procedures and tracing

  • Testing of students, educators and staff  minimally twice a week, with results within 12 hours or sooner.

  • When a student is identified as testing positive, they and their family are immediately contacted and procedures are applied again.

  • Student does not return to school for at least 14 days (or as recommended by their state quarantine protocol), and with a recent COVID test showing a negative status.

  • If the student is in school when the result is reported, a protocol is followed for their safe removal from campus. This includes provisions for an isolation area while they await transport.

  • Contact tracing protocols are developed and followed to identify other students and members of the community who may have been exposed. Exposed students and school community members must quarantine for the duration required by their state and then test negative before readmission to the school campus.

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