Coronavirus Update:What patients and families need to know

Public Health Guidelines for Returning to School

The American Academy of Pediatrics (AAP) updated their COVID-19 Guidance for Safe Schools on July 18, 2021. The goal of the guidance is to "support communities, local leadership in education and public health, and pediatricians collaborating with schools in creating policies for safe schools during the COVID-19 pandemic that foster the overall health of children, adolescents, educators, staff and communities and are based on available evidence."

Additionally, the AAP guidelines are focused on "keeping students safe, since not all students will have the opportunity or be eligible to be vaccinated before the start of the next school year. Since the beginning of this pandemic, new information has emerged to guide safe in-person learning. Remote learning highlighted inequities in education, was detrimental to the educational attainment of students of all ages and exacerbated the mental health crisis among children and adolescents." The Centers for Disease Control and Prevention (CDC) updated their guidance to align with the AAP. Both the AAP and CDC guidance emphasize that safely returning to school for in-person learning is a priority.

Key principles in the AAP guidance include:

All eligible individuals should receive the COVID-19 vaccine.
All students older than 2 years and all school staff should wear face masks at school (unless medical or developmental conditions prohibit use).
Adequate and timely COVID-19 testing resources must be available and accessible.
It is critically important to develop strategies that can be revised and adapted depending on the level of viral transmission and test positivity rate throughout the community and schools, recognizing the differences between school districts, including urban, suburban and rural districts.
School policies should be adjusted to align with new information about the pandemic; administrators should refine approaches when specific policies are not working.
Schools must continue to take a multi-pronged, layered approach to protect students, teachers and staff (i.e., vaccination, universal mask use, ventilation, testing, quarantining, cleaning and disinfecting). Combining these layers of protection will make in-person learning safe and possible. Schools should monitor the implementation and effectiveness of these policies.
Schools should monitor the attendance of all students daily inclusive of in-person and virtual settings. Schools should use multi-tiered strategies to proactively support attendance for all students, as well as differentiated strategies to identify and support those at higher risk for absenteeism.
School districts must be in close communication and coordinate with state and/or local public health authorities, school nurses, local pediatric practitioners and other medical experts.
School COVID-19 policies should be practical, feasible and appropriate for a child or adolescent's developmental stage and address teacher and staff safety.
School policies should be guided by supporting the overall health and well-being of all children, adolescents, their families and their communities and should also look to create safe working environments for educators and school staff. This focus on overall health and well-being includes addressing the behavioral/mental health needs of students and staff.
These policies should be consistently communicated in languages other than English, when needed, based on the languages spoken in the community, to avoid marginalization of parents/guardians of limited English proficiency or who do not speak English.
Ongoing federal, state and local funding should be provided for all schools so they can continue to implement all the COVID-19 mitigation and safety measures required to protect students and staff. Funding to support virtual learning and provide needed resources should continue to be available for communities, schools and children facing limitations implementing these learning modalities in their home (e.g., socioeconomic disadvantages) or in the event of school re-closure because of a resurgence of SARS-CoV-2 in the community or a school outbreak.

It is important for children and adolescents to continue to receive their routine immunizations. This will help avoid outbreaks of other illnesses while the COVID-19 pandemic continues. In addition, the AAP and CDC highly encourage everyone to get the flu vaccine this year if they are medically eligible. It will be important to help reduce the spread of flu this year. The AAP and CDC recommend that anyone over the age of 12 receive the COVID-19 vaccine. Find where teachers, staff and students can get vaccinated here or ask your pediatrician about available vaccination sites. Families with children age 12 and above can request a vaccine appointment from Children’s National by calling 202-476-1002 during regular business hours. For more resources, please visit these resources for D.C., Maryland and Virginia.
Physical distancing needs to be encouraged to the extent possible within the school system, but not at the expense of in-person learning. Studies suggest three feet should be adequate distance to reduce spread, particularly when combined with face coverings. When maintaining a physical distance of three feet is not possible, it is especially important to add additional prevention strategies, but again this should not limit in-person learning. 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.
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.
Schools should determine how they are going to screen staff and students for symptoms. Many remote reporting tools have been developed and implemented to assist with this.
Screening and testing can be used to help evaluate and adjust prevention strategies and provide added protection for schools that are not able to provide optimal physical distance between students. Screening and testing should be offered to students who have not been fully vaccinated when community transmission is at increased levels and offered to all teachers and staff who have not been fully vaccinated. Testing in low-prevalence settings might produce false positive results, but testing can provide an important prevention strategy and safety net to support in-person education.
To facilitate safe participation in sports, extracurricular activities and other activities with elevated risk of transmission (such as activities with singing, shouting, band and exercise), schools may consider implementing screening and testing for participants who are not fully vaccinated. Schools can implement screening and testing of participants who are not fully vaccinated up to 24 hours before sporting, competition or extracurricular events. High-risk sports and extracurricular activities should be virtual or canceled in areas of high community transmission unless all participants are fully vaccinated.
Improving ventilation is an important COVID-19 prevention strategy that can reduce the number of virus particles in the air. During student transportation, open or crack windows in buses and other forms of transportation, if doing so does not pose a safety risk. Funds provided through the Elementary and Secondary Schools Emergency Relief Programs and the Governor’s Emergency Education Relief Programs can support improvements to ventilation.
- Teach and reinforce handwashing with soap and water for at least 20 seconds.
- Remind everyone in the facility to wash hands frequently and assist young children with handwashing.
- If handwashing is not possible, use hand sanitizer containing at least 60% alcohol (for teachers, staff and older students who can safely use hand sanitizer). Hand sanitizers should be stored up, away and out of sight of young children and should be used only with adult supervision for children under 6 years of age.
- 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 also need to include external spaces.
COVID-19 has been very stressful for students, parents and caregivers, teachers, school staff and others. 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 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.
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. It is important that historically underfunded schools and communities have access to the resources needed to open schools safely and provide academic supports to address learning loss during the pandemic.

Coronavirus Update:What patients and families need to know

Public Health Guidelines for Returning to School

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Immunizations

Physical Distancing

Testing and Screening

Ventilation

Cleaning

Mental Health

Racial Equality