In March 2020, the COVID-19 pandemic relocated most K-12 students from their classroom desks to their kitchen tables as schools abruptly shifted to remote instruction to slow the spread of the novel coronavirus. Now, with the new school year quickly approaching, what to do in the fall seems as unclear as ever. Should schools reopen in-person, the stated goal of the American Academy of Pediatrics, given the well-documented benefits of having students physically present in school? Or should schools stick with remote instruction, as districts from California to North Carolina have chosen to do based on high rates of COVID-19 in their communities?
Perhaps the one shared sentiment, besides confusion, is fear. “Understandably, there is so much anxiety from parents, children, teachers, school administrators, and other school personnel about whether to return,” says Donna Hallas, director of the Pediatric Nurse Practitioner program and a clinical professor at NYU Rory Meyers College of Nursing.
Initially, it was believed that COVID-19 largely spared children. Hospitals and health officials were focused on adults—especially older individuals—who were developing serious cases, so testing children was not a priority. But more recent statistics, now that testing capacity has increased, tell a different story. As of July 24, amid a surge of the virus in Florida, 31,150 children in the state had tested positive for COVID-19, with 303 requiring hospitalization—a 34-percent increase in cases for children within only eight days.
And while it’s still unclear just how easily children transmit the virus, one thing is for sure: K-12 schools are facing a fall that will be very expensive for schools trying to reopen, and one that threatens to deepen socioeconomic divides in education already widened by the pandemic.
In two new articles published this month in Contemporary Pediatrics, Hallas and fellow pediatric nurse practitioners Regena Spratling, Emily T. Cupelli, Mary Koslap-Petraco, and Ann Taub present a “call to action” for decision makers to consider when determining whether to reopen schools. The articles outline key steps that school systems must take—if they reopen—to minimize the risk of COVID-19 transmission for children, educators, and families.
Wear a mask!
While messaging from health officials this spring initially discouraged people from wearing masks, and mixed messages from elected leaders have politicized the practice, Hallas notes that there is a growing body of research showing that masks work in preventing the spread of COVID-19, especially indoors.
“The scientific evidence emerging from COVID-19 public health measures undisputedly supports wearing masks as the new norm for all adults and for all children older than two years. Thus, we believe that wearing masks is an essential component of safe return to school,” Hallas and her colleagues write in Contemporary Pediatrics.
Hallas says families and schools can make masks fun for young children by finding or making ones with their favorite characters on them. She also recommends that students wear eye protection—such as kids’ swimming goggles—to keep them from touching their eyes.
Create a plan to test, screen for symptoms daily, and trace contacts.
Bringing students, teachers, and staff back into the classroom will require a multi-layered approach to catch COVID-19 cases before they enter or spread through schools, says Hallas.
The first step: testing.
“Testing all students and school personnel prior to reopening schools is the cornerstone of primary prevention,” Hallas says. Identifying positive cases before school starts lowers the risk of schools having to shut down when new cases are detected—which can disrupt learning.
Another safety measure: daily symptom checks. Some organizations (including NYU) have developed apps in which individuals log in daily to report their temperature and answer a series of questions about symptoms and possible exposure. This type of screening could be adapted for K-12 schools, with parents or older students completing a questionnaire each morning.
If and when COVID-19 cases are identified, Hallas says schools should work with their local health departments, who can notify those who have been in contact with the COVID-positive individuals.
Rethink how schools use and clean spaces.
Public health experts now know that COVID-19 transmission is more likely indoors, which has led school officials around the world to consider moving classrooms outside. While weather may be a challenge at times, and usable outdoor space hard to come by in urban areas, outdoor classrooms should be “part of the ‘new norm’,” according to Hallas.
Hallas also notes that several spaces beyond the classroom warrant close attention during the pandemic—think water fountains, which she says should be off-limits for the time being, and bathrooms, which need extra precautions given their potential to spread the virus. The risk in school bathrooms can be mitigated by frequent cleanings throughout the school day, and bathroom sinks should ideally offer no-touch faucets and no-touch soap dispensers. Other structural changes, like making sure all toilets have covers that close prior to flushing—which may prevent the virus from being sent airborne during a flush— “must be considered a top priority,” Hallas writes. Students may also need to have scheduled bathroom times to limit the number of kids who congregate there.
Planning should also consider how children get to and from school. For children who ride a bus, a bus monitor may help kids socially distance while in transit, and the bus should be cleaned between trips. For students who are driven to school, parents should drop off and pick up their children without leaving the car to chat with other parents.
Create safe “circles” for students.
Hallas recommends schools create small, stable groups of children—called “circles” or “cohorts”—who can learn, play, and eat together, and who don’t mix with other students during the school day. This lowers the number of students interacting with each other and makes it easier for contact tracing and quarantining to take place if a COVID-19 case is identified. (These groups are different from “pandemic pods” or “micro-schools” that families are forming outside of schools.)
Student movement around the school and classroom should also be limited, Hallas explains. For instance, students should have assigned desks and chairs so as not to share furniture. Middle and high schoolers could stay in the same classroom with their teachers rotating to see them, rather than hundreds of students moving through the hallway between classes. Students could also eat lunch in their classroom, rather than having to mix “circles” in the lunchroom.
We need a nurse in every school.
"School nurses will play a critical role in the management of health, including the prevention and control of transmission of the novel coronavirus, for all who return to school, not only the children," says Hallas. (Unfortunately, only three out of five schools currently have a full-time nurse on staff
In addition to monitoring daily symptom screenings, tracking COVID-19 test results, and coordinating with local health departments for contact tracing, school nurses can also be an educational resource for COVID-19 prevention on topics including proper hand hygiene and use of masks.
Hallas adds that school nurses have also always played a role in gathering and monitoring student immunization records, and this may be especially important this year as routine vaccinations have dropped sharply during the pandemic.
“Schools and children do not need the additional crisis of unimmunized or underimmunized children contracting a vaccine-preventable disease during the pandemic,” says Hallas.