The COVID-19 pandemic has drastically altered the familiar back-to-school ritual this fall as schools around the United States and across the globe mull whether to offer in-person education, remote learning or a hybrid of both.
Dr. Jason Wang, a pediatrician and director of the Center for Policy, Outcomes and Prevention at Stanford University, said the best option is to resume regular teaching, as long as special — and expensive — measures are taken.
“Prolonged school closures can exacerbate socioeconomic disparities, causing negative education and health outcomes, and amplifying existing educational inequalities,” Wang said in a press release. “School closure may also aggravate food insecurity, domestic violence and mental health disorders. Many children from low-income households obtain food through the National School Lunch Program, and estimates suggest that one in four children may face hunger this year due to COVID-19.”
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Wang says that each school district should form a task force made up of the superintendent, members of the school board, teachers, parents and health care professionals. They should develop policies and procedures for the district to adhere to during this uncertain time.
“To implement and evaluate specific measures, the task force should create and oversee a command center for the school district, composed of data analysts and health experts who can liaise with the local health department,” Wang wrote in an Aug. 11 JAMA Pediatrics article co-authored by Stanford medical student Henry Bair, who is also working on a master’s in business administration degree at the university’s graduate school of business.
Among their recommendations to school task forces are to work with local health departments to provide educational materials and training for students, parents and school staff on the basics of COVID-19 prevention. They also say that school staff should be equipped with thermometers and trained to screen for COVID-19 symptoms.
Districts should build temporary modular buildings if schools cannot maintain six feet of physical distance among students and teachers, the article advised, and expand the district’s fleet of school buses or develop different pickup schedules. These efforts will not be cheap, the authors caution.
Schools will need to increase their budgets to boost disinfection efforts of all teaching spaces, common areas and high-touch surfaces such as doorknobs, computers and desks, according to the article. They will need to install transparent plastic shields in front of and along the sides of student desks and provide hand sanitizers and protective equipment, such as disposable surgical masks, reusable cloth masks or reusable face shields.
The authors were guided by a report on reopening schools released by the American Academy of Pediatrics, which advocated for resuming classes if it was safe in the area.
“Schools and school-supported programs are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction, either in person or virtually; social and emotional skills; safety; reliable nutrition; physical/speech therapy and mental health services, and opportunities for physical activity, among other benefits,” the AAP article stated. “Schools also serve as critical centers in communities by supporting adult-focused activities [such as job training, neighborhood meetings and parenting classes] as well as ensuring safe places for children and adolescents to be while parents or guardians are working, which in turn supports the local economy.”
The article listed several “key principles” to reopening schools. However, it did offer a caveat.
“With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school,” the report stated. “Unfortunately, in many parts of the United States there is currently uncontrolled spread of SARS-CoV-2. Although the AAP strongly advocates for in-person learning for the coming school year, the current widespread circulation of the virus will not permit in-person learning to be safely accomplished in many jurisdictions.”
Wong and Bair recommended a “three-pronged testing approach” for schools working in concert with local hospitals:
1) Test all students with symptoms.
2) Devise a schedule to randomly select a proportion of students and staffers for COVID-19 testing to identify asymptomatic individuals. The researchers note that a pooled testing strategy can significantly reduce costs.
3) Offer more frequent testing to students from high-risk households in ZIP codes with socioeconomic challenges.
Although these measures will be costly, the price of closing schools and keeping 55 million students at home has been high as well. Wong notes that the Centers for Disease Control and Prevention reported in its July 24 telebriefing that 5.6 million parents unable to work because of school closures lost an estimated $232 billion in earnings.
He also says that federal and state governments must offer assistance to low-income communities where obtaining safety equipment could be difficult if not impossible. A transparent desk barrier costs between $100 to $200 per desk and COVID-19 tests cost anywhere from $50 and $200.
“Low-income communities are suffering most from shelter-in-place policies because parents who are essential workers are out of the home and not able to help with online learning,” Wang said. “And many children in these communities also live in crowded conditions that are not conducive to learning at home.”
Wang and Bair recommend that schools implement “multilevel screening for students and staff,” with parents reporting any fever or other COVID-19 symptoms to an online or automated telephone-based program maintained by the school or district. Students displaying symptoms should remain at home.
Despite these efforts, they said outbreaks are “likely” and schools should be prepared for temporary closures and a return to online education. To do so they should invest in remote education platforms and training.
“Schools will need to ensure equitable implementation of online education among students, especially those with limited knowledge of or access to technological resources and consider subsidizing educational technologies for these students,” they wrote.
Wang told the Lone Star Standard that it is a fluid situation and people will have to adapt.
“This is a new virus and our understanding of the science changes daily,” he said. “It is better to be humble and cautious. We should change clinical practice based on new scientific evidence and local conditions.”
