Coronavirus Update:What patients and families need to know
Public Health Guidelines for Returning to School
The American Academy of Pediatrics (AAP) released guidance for school re-entry on June 26, 2020. The goal of the guidance was to ensure school districts are considering all of the risks of children and adolescents not being in schools – not just the risks of spreading COVID-19. Schools provide much more than just instruction to students and all those services play a role in helping students develop healthily. The AAP also notes schools will need additional resources to re-open schools safely. This was emphasized in a joint statement released with the American Federation of Teachers, the National Education Association and AASA, the School Superintendents Association, on July 10, 2020.
There are several guiding principles that the AAP believes needs to be part of any plan to re-open schools:
- School policies must be flexible and nimble in responding to new information.
- Develop strategies that can be revised and adapted depending on the level of viral transmission in the school and community.
- Policies should be practical, feasible and appropriate for child and adolescent developmental stages.
- Special considerations and accommodations to account for the diversity of youth should be made, especially for our underserved populations, including:
- those who are medically fragile
- live in poverty
- have developmental challenges
- or have special health care needs or disabilities, with the goal of safe return to school.
- No child or adolescents should be excluded from school unless required in order to adhere to local public health mandates or because of unique medical needs.
- Pediatricians, families and schools should partner together to collaboratively identify and develop accommodations, when needed.
- School policies should be guided by supporting the overall health and well-being of all children, adolescents, their families and their communities.
Physical distancing needs to be encouraged for everyone in schools, but recognizing it will be more difficult to implement at different ages. Studies suggest three feet should be adequate distance to reduce spread, particularly when combined with face coverings. For younger students, reducing group size and keeping groups together (cohorting or pods) will help reduce the risk of spread to more individuals. For older students, spacing desks and having them face the same direction will help improve the effectiveness of physical distancing.
Strategies need to be put in place for several special areas or situations for schools:
- School Buses: Ensuring masking and spacing students with either assigned seats or empty seats will help reduce exposures.
- Hallways: Reducing the volume of traffic by having teachers change classes or reducing the number of moves a day by using block schedules (classes meeting 2-3 times a week for longer times instead of every day) or using directional arrows to help with flow.
- Cafeteria/Meals: Scheduling meals to help manage group sizes. Using alternative spaces such as outdoor spaces or classrooms to help achieve this.
- Playgrounds: Managing group sizes so children can play. If playground equipment is being used, it should be part of the cleaning plan.
- All students and staff should wear face coverings if possible, based on medical needs and developmental level.
- Younger children (less than 8 years old) may struggle with wearing face coverings. In addition, if children are touching their face too frequently due to the face covering, the face covering may lose its value.
- There are very few medical conditions that would exempt a child from needing to wear a face covering.
- Most children can safely wear face coverings with practice and modeling by adults.
Everyone in schools should be encouraged to wash their hands frequently, either with soap and water or hand sanitizer. Schools also need to have cleaning plans to ensure high touch areas (such as doors, railings, lockers, desks) are cleaned at least daily. The plans need to include external spaces, as well as needed based on use.
Testing is not recommended prior to return to school. It will only create a false sense of security and encourage ignoring other strategies to the contain COVID-19. Students or staff who become sick during the school year, either at school or home, should be encouraged to connect with their medical provider to determine if they need testing.
Temperature and symptom screening students and staff upon arrival at school may not be feasible. However, schools should determine how they are going to screen staff and students. Many schools are looking at ways for parents to report that data remotely.
Regardless of whether school is in-person or virtual, it is important for children and adolescents to continue to receive their shots. This will help avoid outbreaks of other illnesses while the COVID-19 pandemic continues. In addition, everyone should get the flu vaccine this year if they are medically-able. It will be important to help reduce the spread of flu this year.
COVID-19 has been very stressful for all of us. Children and adolescents have been impacted by being disconnected from their friends, classmates and teachers, as well as all the strain and stress of COVID-19 on children and their families. It means schools can expect to see students with decreased attention spans, increased anxiety and other symptoms related to stress and trauma. Schools also need to make sure staff and teachers are getting support for their mental health needs during this period.
School districts are also preparing for prolonged periods of virtual learning this academic year. What many envisioned as a temporary disruption in the services provided in the school setting, such as school-based mental health care and access to supportive adults and peers, now appears to be a prolonged state, placing the mental health of children and adolescents at increased risk. Data from the UK indicate that 83% of students surveyed said the pandemic had made their mental health conditions worse. Data from California show "More than half the students who responded to the survey said they’re in need of mental health support since the school closures began in mid-March. That includes 22% who said they were receiving some kind of support before the closures but now have limited or no access to those services and an additional 32% who said their mental health needs have arisen since schools closed.”
Longer quarantine duration is associated with worse mental health outcomes, and extended periods of virtual learning place students at further risk for social isolation. In communities where virtual learning will continue, it is critical that the education and health sectors employ active outreach to students and families, that educators and health care providers are trained in trauma-informed practices, and that telehealth opportunities for mental health care are maximized.
Historical and structural racism have led to chronic underfunding of schools that serve higher populations of students of color. Research during the pandemic shows that Black, Latinx and Native American students have less access to electronic devices, internet connectivity and quality virtual learning programs. Due to these inequities, Black and Latinx students may experience an additional three months of learning loss compared to other students. Black, Latinx and Native American communities also experience a disproportionate burden of disease and death due to COVID-19, as a result of longstanding health and social inequities. As school districts consider a return to school, either in person or via distance learning, they must apply a racial equity lens. This includes consideration of the inequities of virtual learning and its implications for academic achievement, and the inequities in disease burden and its implications for a family’s choices and risks in returning to school.