Questions for parents to consider as schools reopen

July 22, 2020
PHOTO: Getty Images

As we near the end of summer and schools share their plans for reopening, there are, undoubtedly, many questions parents and caregivers have due to COVID-19’s impact on our communities. There are certainly no easy, one-size-fits-all answers to these questions. After all, we are facing an unprecedented situation. Both the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) have published guidance documents addressing safety measures that schools and parents can practice to mitigate risk. These measures do just that—mitigate—but they cannot eliminate all risk of acquiring COVID-19.

The questions below may be top of mind and I’m hopeful this guidance helps you make the best decision for your family.

What should schools consider when developing reopening policies?

Schools should work closely with state and/or local public health authorities to develop and modify policies, taking into account the extent of COVID-19 transmission in their local communities. Flexibility in adjusting and modifying strategies is essential if a proposed approach is less effective than expected, or when community or school transmission and infection rates fluctuate.

Policies must account for, and be feasible for, the child’s developmental stage and allow accommodation for vulnerable populations, including those with underlying health issues, disabilities, and psychological and socioeconomic hardships, with the ultimate goal of safe physical return to school.

School policies should be clearly, repeatedly and consistently communicated to parents, students and educators. Education for the entire school community regarding safety measures and expectations should begin early, ideally at least several weeks before the start of the school year.

What about testing and screening?

Testing: Universal testing of all students prior to starting school is not a feasible strategy in most cases, and testing only detects if a person is currently infected. Antibody tests only determine if the person has previously been infected and many are notoriously inaccurate. Immunity may also not be long lasting. Tests may be negative during the early incubation period and do not indicate that someone may not subsequently become positive.

Screening: Schools may consider implementing policies for daily temperature checks and symptom screening of students and staff, and policies to address situations when a student or staff member does not pass.

  • It may not be feasible to conduct screenings for large numbers of people at school entry points, and schools can consider reporting mechanisms for home temperature checks and symptom reporting by parents prior to school arrival.
  • Parents should be instructed to keep their child home if they have fever and/or if they are sick.
  • School nurses should be equipped to measure temperatures and should have an identified area to separate or isolate students who develop symptoms while at school, until they can leave the school.

What if my child is exposed to COVID-19 at school?

Students or staff with a known COVID-19 exposure or symptoms of the virus should not go to school. Schools should coordinate with local public health authorities to identify any COVID-19 infections in the school, any needed contact tracing and potential school closure.

Schools and school districts should have policies for criteria for staff to return to work and students to return to school consistent with CDC and public health recommendations.

What are some safety measures that schools should take to decrease the risk of COVID-19 infection/spread?

  • Ensure social distancing and face coverings (School staff and teachers should universally mask and maintain social distancing):
    • Pre-K:
      • Cohort classes to minimize crossover among children and adults within the school so the same group of children stay in same classroom during the day. The same teacher should stay with the students, or, if needed, teachers rotate to each room.
      • Utilize outdoor spaces as much as possible.
      • Limit unnecessary visitors.
      • Face coverings and social distancing are difficult to implement at this age.
      • Reducing classmate interactions/play may not provide substantial reduction in risk.
    • Elementary School:
      • Cohort classes to minimize crossover among children and adults within the school as mentioned above.
      • Utilize outdoor spaces as much as possible.
      • Limit unnecessary visitors.
      • Educate children about the proper use of face mask/covering, including avoiding hand to mouth/nose contact after the mask is in place. Younger children at this age may not be able to successfully wear a mask for long periods of time.
      • Desks should be placed at least 3 to 6 feet apart as space permits. Closer spacing, such as 3 feet, may be an option when children can be masked.
    • Middle/High School: *Social distancing likely has a greater impact on transmission at this age than younger kids.
      • Universal face coverings.
      • Desks should be placed at least 3 to 6 feet apart as space permits.
      • Ideally, activities like singing or exercise should be done outside with students at least 6 feet apart. Utilize outdoor spaces as much as possible.
      • Limit student and teacher crossover as much as possible by instituting block scheduling.
      • Eliminate and reduce hall traffic by eliminating lockers, if possible, utilizing one-way hallways, placing distance markers on the floor, etc.
      • If possible, teachers should rotate through classrooms instead of students.

For all ages, special accommodations may be needed for students at increased risk of complications from COVID-19, especially immunocompromised children.

  • Practice good hand hygiene and sanitation: The main mode of transmission of COVID-19 is via droplets, such as coughing or sneezing. However, as the virus may survive on certain surfaces for some time, it is possible to get infected after touching a virus-contaminated surface and then touching the mouth, eyes or nose. Frequent handwashing and surface cleaning are vital to mitigate the spread.
    • Train staff and students on proper hand hygiene techniques. Teachers should serve as role models and reinforcers of good hygiene practices.
    • Ensure hand hygiene products are available throughout the school and in classrooms.
    • Set expectations and breaks for hand hygiene at set times, including at school and classroom entry, before and after eating, and after touching the nose or mouth.
    • Minimize shared equipment and ensure hand hygiene before and after use.
    • Incorporate frequent cleaning of high-touch surfaces and objects throughout the day. Restrooms, sinks and faucets should be cleaned multiple times per day.
  • Manage meals and cafeteria time:
    • Minimize number of children eating in cafeteria at any given time to maintain strict social distancing.
    • Consider eating in classrooms at desk instead of in cafeteria.
    • Utilize outdoor/additional spaces for eating.
    • Serve prepackaged meals, disposable utensils, encourage meals from home.
  • Outdoor transmission of virus is known to be much less likely than indoor transmission. Enforcing physical distancing in an outside playground is challenging and may not be the most effective method to reduce risk. Emphasis should be placed on grouping students and limiting the number of students on the playground at any given time.
     
  • Consider transportation:
    • Walking or personal modes of transportations should be encouraged as much as possible.
    • If students are riding the bus:
      • Minimize the number of riders at any given time.
      • Assign or group seating and make sure it is marked.
      • Bus riders should wear face coverings, definitely if closer than 6 feet apart.
      • When possible, open windows.
      • Screen students for symptoms ideally before arriving for boarding.
      • Bus drivers should wear a mask, maintain social distancing from students. Consider a plexiglass shield to separate the driver from students.

These and many others are common questions and considerations for parents and caregivers of school-aged children. There is understandable uncertainty for parents regarding whether schools will or should physically open, and whether they should send their children to school if/when physical reopening occurs.

Ultimately, the decision of whether to send a child back to school will be a personal one for each family, incorporating the overall physical and emotional health of the child, presence of high-risk underlying medical conditions in household members, the ability to learn virtually, the extent of community spread, the family structure and finances, and parent’s/child’s comfort level.

Post by:

Galit Holzmann-Pazgal, MD

Dr. Holzmann-Pazgal is focused on high quality, patient-centered care.  She is an advocate for patient safety and has interest and expertise in infection prevention and control. She provides care for children with infectious diseases in the inpatient and outpatient setting at TCH West Campus....

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