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How should schools reopen? Pediatricians offer these guidelines

The nation’s top pediatricians are urging educators to plan for in-person teaching at schools this fall, citing the fundamental benefits to children’s well-being. But those guidelines — released just as new cases of the coronavirus were hitting records in the United States this week — raise concerns about ever-present risk, educational inequities and basic logistics.

Pandemic or no, children learn best in an actual classroom, the American Academy of Pediatrics said in a June 25 statement. School offers a structured place for children to grow academically, but also mentally and emotionally. It is where children learn how to share and socialize. School regularly serves as a stable source of nutrition for children who live in food-insecure homes, structured education for students with special needs and security for those at risk of child abuse, neglect and trauma.

“We need to get kids back in school,” said Dr. Jack Shonkoff, who directs the Center on the Developing Child at Harvard University. “They can be out of school for a while, but when you get to months and months of kids being out of school, the consequences become more and more serious.”

While millions of Americans have been sickened by the virus, resulting in the deaths of more than 120,000 in this country alone, the organization said evidence suggests children “may be less likely to become infected and to spread infection,” as well as “less likely to be symptomatic and less likely to have severe disease” if they become infected with the virus.

To reduce the risk of COVID-19 infections upon reopening, child health experts at the AAP and with other organizations said schools can take precautions like physically distancing children, requiring face coverings and washing hands regularly. But those experts also cautioned that such recommendations do not “eliminate” the risk, and also that school districts may not have the space or resources to pull them off.

Again and again, COVID-19 has reshaped our daily lives and toppled long-term plans seemingly overnight. Even with the best intentions to reopen, school districts can’t say for certain what’s going to happen in the coming months, or even if they will have adequate funds to pull off the changes. The latest guidance encourages educators and parents to “be flexible and nimble in responding to new information.”

But for those that make the attempt, what should school look like under the current circumstances? Here’s a look at the AAP guidelines, and what experts — and parents — have to say about them.

What the American Academy of Pediatrics recommended

  • Physical distance: While the Centers for Disease Control and Prevention says it is best for students to stay at least 6 feet from one another in the classroom, the academy pointed to evidence that 3 feet could be safe if children wear face masks and no one shows symptoms of COVID-19 infection. There was more concern about adults, including teachers, staff and parents, spreading the virus if they did not stay at least 6 feet apart during drop-off, pick-up or throughout the school day. Given the differences in developmental stages from preschool to high school, the academy offers age-appropriate strategies on topics such as spacing out desks, eliminating lockers, clustering students into cohorts for high-traffic moments like changing classes and encouraging use of outdoor space when possible.
  • Cleaning and disinfection: To keep schools clean and prevent surface transmission of the virus, staff can use normal soap and water, along with EPA-approved disinfectants that do not harm humans or the environment, such as hydrogen peroxide, ethanol or citric acid. When possible, leave doors open at all times to prevent high-touch transmission from door handles.
  • Testing and screening: Schools need to develop a practical protocol to screen students and staff and what to do if they develop COVID-19 symptoms, the AAP says. Parents should keep their children home if they’re showing symptoms. Schools should consider setting up texting apps, phone services or online portals where parents can log temperature checks, but explore other methods for parents who don’t have access to these devices or who do not speak English at home and may need language assistance.
  • Face coverings and PPE: Face masks may prevent the virus from spreading, especially if the person wearing the mask doesn’t realize they are infected. Middle and high school students should wear masks. Preschool and elementary students should wear masks, but if these coverings become a distraction (or attract tiny hands to touch their own faces more often than usual), the academy suggested greater reliance on physical distancing.

FILE PHOTO: A classroom sits empty ahead of the statewide school closures in Ohio in an effort to curb the spread of the coronavirus, inside Milton-Union Exempted Village School District in West Milton, Ohio, U.S., March 13, 2020. REUTERS/Kyle Grillot

What child experts say about going back to school

With COVID-19 cases already surging in many states, “we’re all pretty nervous right now about just about everything we’re doing,” according to Dr. Sean O’Leary, a pediatrician, an infectious disease specialist, a professor, and vice chair of the American Academy of Pediatrics Committee on Infectious Diseases, said during an interview with the PBS NewsHour’s William Brangham.

A trained pediatrician who has studied child brain development for years, Shonkoff applauded these guidelines, but said that for everyone involved, the decision to return to school is incredibly complex.

While keeping kids out of school for months won’t automatically mean every child’s life is “ruined”, Shonkoff said, it exposes some children to greater risk of more adverse outcomes, such as developing depression or anxiety, due to their losing access to essential supports like regular access to food and counseling services.

Time away from structured school and learning is also “broadening the achievement gap like crazy,” said Megan Gunnar, a developmental psychologist who directs the Institute of Child Development at the University of Minnesota. That is especially true for children who already struggled with basic needs inside and outside the classroom, including those without reliable internet access or access to a computer — tools that have become essential during distance learning under COVID-19.

“Even under the best of circumstances, learning has been slowed down during this period of time,” Gunnar said. “We can’t go an entire year without learning.”

To make a return to school a reality, Shonkoff said more COVID-19 testing must be available, in the classroom and elsewhere, to catch potential outbreaks. Without that, school officials will have no idea if efforts like the ones recommended by the AAP are working to prevent the virus’ spread, adding that the only way to slow an infectious disease is the ability to track and contain it quickly.

This is how schools and public health officials “know what’s working and what’s not,” Shonkoff said. “Without good, reliable testing, you’re flying without radar.” And to achieve community compliance and keep students, faculty, staff and all families safe, Shonkoff said “informed, enlightened, trusted leadership” is essential.

FILE PHOTO: A Brooklyn student begins digital classes in March 2020. Photo by REUTERS/Caitlin Ochs. REUTERS/Caitlin Ochs

Challenges of making these changes

Schools need to bring together educators, public health officials, parents, civil rights and community leaders to figure out when and how to best reopen, said Becky Pringle, a middle school science teacher with three decades of experience and the vice president for the National Education Association, the nation’s largest teachers union.

She agreed with pediatricians that different students have different needs and that all stakeholders must be taken into account in determining when and how schools reopen. She said precautions need to be put in place to help students — and teachers — who are more at risk of getting seriously ill, or whose family members could suffer severe outcomes. Teachers are being asked to go back to school and may be wrestling with their own concerns about how vulnerable they might be to the virus, she said.

In the same vein, all models for going back into the classroom — including creating half-day schedules, staggering the days on which students are on campus, or alternating in-person and distance learning on a weekly basis — present strengths and weaknesses, she said. . But parents need to be included in those conversations to come up with creative — and realistic — solutions.

Educators and communities also need to think about how to transform the classroom experience for kids beyond the current crisis, she said, “so we’re not further adversely impacting those communities that forever have been marginalized.” She noted that before the pandemic came along, some children across the U.S. already attended low-resourced, sometimes rodent-infested schools where basic defenses against the virus, like soap in student bathrooms, might be in short supply or unavailable, in addition to technology and opportunity gaps that reinforce systemic inequities.

None of these changes come cheap, and schools need money so they know how to plan, Pringle said. On May 15, the U.S. House of Representatives passed the Health and Economic Recovery Omnibus Emergency Solutions, or HEROES Act, which included $200 billion to cover state and local expenses. Those dollars could buy personal protective equipment and supplies to use in schools after students are allowed to return. Shortly after the House passed the bill, Senate Majority Leader Mitch McConnell, R-Ky., said the bill had little chance of passing in his chamber as written.

On Wednesday, senators introduced the Coronavirus Child Care and Education Relief Act, which built in $175 billion for K-12 schools, with additional funds for special education, and $430 billion for child care.

“We need the funding now because we’re planning now,” Pringle said. “We have to know now.”

FILE PHOTO: A table of free books for local children sits at a meal distribution site at Denny International Middle School during the outbreak of coronavirus disease (COVID-19), in Seattle, Washington, U.S. March 17, 2020. REUTERS/Lindsey Wasson

How parents feel about going back to school in the fall

Before the COVID-19 pandemic disrupted her family’s life, Randi Burlew’s 10-year-old son attended a Montessori school with nearly 150 students ranging from preschool to sixth grade in Cincinnati.

A psychologist, Burlew traveled for work at least twice a month, researching and evaluating teen pregnancy programs for schools. Her husband worked as a data scientist. Since mid-March, they have followed stay-at-home orders. Their jobs have been flexible and family-friendly — “a luxury that not everyone has.” Working from home has allowed them to manage the education of their son, who is independent and healthy, Burlew said, but it also placed unexpected demands for their time and attention as parents during the work day.

Keeping equity in mind, Burlew said schools should prioritize welcoming back children who have been hurt most by social distancing, especially those with special needs, who experience food insecurity and who have suffered steep learning losses due to lack of access to technology to keep them connected to classes.

At the same time, “not every parent is going to have the same risk tolerance” for sending their child back, Burlew said. She said she has been very concerned about her son returning to school, and knows that it is inevitable that if he does rejoin a physical classroom, he will be in a large group.

As confirmed COVID-19 cases spike in several states ahead of the Fourth of July holiday, Burlew also said parents and kids are getting mixed messages. Her husband’s employer has no set date when it is safe for him to return to the office. At the same time, her son’s school is still scheduled to reopen in mid-August.

“That has an element of cognitive dissonance for us,” she said.

And many school districts will be dealing with that on a larger scale. Mike Haudenschild directs information technology for Lakewood Local School District in Hebron, Ohio, which teaches 1,800 students, including his 6-year-old son. After Ohio schools suddenly shut down on March 12 to prevent further spread of the virus, Haudenschild said he worked seven-day weeks for nearly a month to set up devices and internet hotspots for hundreds of students who otherwise wouldn’t have been able to stay connected to their classes and continue to learn.

He acknowledged the benefits of on-campus school (he and his wife, a chemistry teacher in the same district, fear their son missed out on careful reading instruction from his kindergarten teacher this spring), but logistical hurdles of getting all students back into the classroom still baffle him. How do you schedule school bus routes when they can only hold kids at 20 percent of capacity? How do you safely teach children in a classroom designed to hold 20 kids while following social distancing of 6 feet? (“You can’t just spread desks apart.”) And he’s skeptical that his son can wear a face mask all day at school (“He’s 6. He loses things all the time.”)

Everything the AAP is “saying makes absolute sense and is completely right,” Haudenschild said, “but we bump into some very practical limitations very quickly.”

On July 1 in his school district, Haudenschild said administrators would normally be up in arms if they did not have concrete plans for the next school year. Under a swiftly moving pandemic, he said, “we have absolutely no idea what the start of school looks like.”

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