School Reopening

On-Site Staff

With the reopening of schools this fall being left mainly to individual districts rather than set nationwide standards, many different approaches have been put forth to tackle this issue. There are a handful of changes that research states should be widely adopted to increase the safety of students, faculty, and staff.

In primary schools, among the most critical measures to be tackled are testing, physical distancing, hygiene, and isolation of positive cases. Large-scale testing has been suggested, but at this time, it is not seen as feasible to test all students before returning to school (1). This level of testing would require child-friendly methods as well as non-traditional testing sites such as in-home testing (2).

As has been successful in the reopening of schools in Norway, many districts are adopting the idea of ‘cohorts.’ These are fixed groups of students and corresponding staff designated to reduce contact with other students and allow for simplified contact tracing. No more than one cohort would be in a classroom at a time (3). Physical distancing should be of the highest priority, as COVID-19 is spread primarily via respiratory droplets. This includes spacing of desks, decreased number of students per classroom, and utilizing outdoor spaces when possible. This also includes limiting opportunities for large gatherings in enclosed spaces. It has been suggested that meals be served in classrooms with respective cohorts and hallways be made one-way (1).

Many schools are utilizing staggered start times, discouraging staff congregation, and discouraging parents from entering the building to limit the number of adult-adult interactions (1). Parents are also advised not to congregate at bus stops where many children will have their temperatures checked before boarding a bus with limited capacity (4). In-person exceptions should be made, and the option of working remotely should be provided to staff over 60-years-old or those with underlying health conditions. All on-campus staff should be provided with appropriate PPE (5).

Hygiene has been the cornerstone of limiting disease transmission and should remain so with school reopening. Proper hand-washing practices should continue to be emphasized. High-touch areas should be cleaned at least once daily and more often if possible, especially when rotating between cohorts (3). Johns Hopkins University has launched a school reopening policy tracker to provide up-to-date information on guidance in each state(6).

Further challenges have been identified in discussions of reopening colleges and universities. While universal mask requirements have not been posed for primary schools, it is of greater concern in colleges where the age of students has shown to be more susceptible to contracting COVID-19 (7). Widespread testing every two days has been suggested as the required frequency to control outbreaks in combination with proper isolation strategies for positive individuals (8). Of high importance is the de-densification of campuses, including dormitories, classrooms, and dining halls. While this is imperative in curbing the spread of the virus, this poses substantial financial issues for many institutions (9). De-densification may consist of fewer students sharing dorm rooms, limiting dormitory access to one entrance, and limiting the number of students per table in dining halls (7).

In many colleges and universities, international travel will be discouraged, and testing will be required before returning to campus. Schedules for some universities returning in the fall will be adjusted to virtual learning for the remainder of the semester after Thanksgiving break to limit travel back to campus (10). Many colleges are also adopting the use of contact tracing apps in the event of a positive case.

References:
1. American Academy of Pediatrics. COVID-19 Planning Considerations: Guidance for School Re-entry. 2020 Jun; 
2. Dan M. Cooper, MD1, *, Lisa Guay-Woodford, MD2, *, Bruce R. Blazar, MD3, , Scott Bowman, MS4, , Carrie L. Byington, MD5, , et al. Reopening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-Coronavirus 2019 Expectations, and Creative Solutions. J Pediatr. 2020 Aug;223. 
3. Tone Bjordal Johansen, Elisabeth Astrup, Hege Nilssen, Bente Barton Dahlberg, Claus Klingenberg, Are Stuwitz Berg, et al. Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway. Eurosurveillance. 2020 Jun; 
4. Goldstein D. What Back to School Might Look Like in the Age of Covid-19 - The New York Times [Internet]. 2020 [cited 2020 Aug 4]. Available from: https://www.nytimes.com/interactive/2020/07/29/us/schools-reopening-coronavirus.html?action=click&module=RelatedLinks&pgtype=Article
5. Meira Levinson, D.Phil., Muge Cevik, M.D., Marc Lipsitch, D.Phil. Reopening Primary Schools during the Pandemic. N Engl J Med. 2020 Jul; 
6. Johns Hopkins University. Johns Hopkins University eSchool+ Initiative [Internet]. [cited 2020 Aug 4]. Available from: https://equityschoolplus.jhu.edu/reopening-policy-tracker/
7. Cheng S-Y, Wang CJ, Shen AC-T, Chang S-C. How to Safely Reopen Colleges and Universities During COVID-19: Experiences From Taiwan. Ann Intern Med. 2020 Jul 2; 
8. Paltiel AD, Zheng A, Walensky RP. Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States. JAMA Netw Open. 2020 Jul 31;3(7):e2016818. 
9. S.  Wrighton M, J.  Lawrence S. Reopening Colleges and Universities During the COVID-19 Pandemic. Ann Intern Med. 2020 Jul 2; 
10. Schweigert K. Central PA colleges announce plans for fall semesters amid COVID-19 outbreak | fox43.com [Internet]. [cited 2020 Aug 4]. Available from: https://www.fox43.com/article/news/health/coronavirus/central-pa-colleges-announce-plans-for-fall-semesters-amid-covid-19-outbreak/521-3752c936-1611-4944-9c42-a303161eb4aa

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