Risks and Safety Precautions in the School Reopening Guidelines

Typically, the last few weeks of August signal back-to-school season for parents. For every family, that ritual looks different: organizing supplies, adjusting sleep schedules for an easier adjustment to the school day, perhaps preparing an outfit or simply trying to make the most of the remaining days of late summer. But in the wake of the coronavirus (COVID-19) pandemic, this year is drastically different. As September approaches, many parents are anxiously awaiting to learn whether their school will offer remote learning options--and making difficult decisions about whether it's safe to send their children back.

The Massachusetts Department of Elementary and Secondary Education (DESE) has released comprehensive initial reopening guidance for districts and schools to follow. These guidelines include goals and health and safety requirements, and require schools to develop detailed reopening plans based on several criteria. Still, with so much uncertainty surrounding infection rates in the weeks to come, many parents remain uneasy.

Ann Murray, MD, MPH, is a pediatric infectious disease specialist and primary care physician at Mass General for Children. She also teaches pediatrics to medical students at Harvard University and is the mother of a preschooler. With this knowledge and experience, she offers her insight on the risks and safety precautions that are outlined in the reopening guidelines to help parents feel confident in their next steps.

With Proper Resourcing, Schools May Safely Reopen

"The initial school reopening guidance is very thoughtful and clearly evidence-based," says Dr. Murray. "We can safely open schools for all ages if the schools are given the resources to carry out proposed health and safety requirements in the guidance."

The safety requirements, heavily based on guidance from the Centers for Disease Control and World Health Organization, ask that students and educators:

• Physically distance from one another
• Wear masks
• Stay home when sick
• Wash their hands frequently

Can Students Cooperate?

Children are less likely to experience severe symptoms of COVID-19, but researchers need more data to fully understand why. Older kids may be more likely to get sick with COVID, but they are also better at following directions such as washing hands and wearing their masks properly. In general, before the COVID-19 pandemic, infections in high schools were lower than in elementary schools.

Although some of these requirements may seem difficult for young ones to follow, Dr. Murray notes that, overall, efforts to educate the public about the importance of rules such as wearing masks seem to be working exceptionally well with children.

"If a safety procedure is a consistent requirement, kids become used to it and see it as necessary and even become advocates for it," she says.

Dr. Murray explains that safety procedures become routine, kids tolerate them even if they are not the most comfortable. As a parent, she has witnessed her three-year-old child tolerating a mask, much like she tolerates wearing a helmet in order to ride her scooter. Pediatric patients wear their masks at doctors' appointments and they even hesitate to remove them when they are asked to do so for a throat examination.

Every child is different, however, and some kids will not tolerate masks, especially children under age five and those with sensory or medical issues such as lung problems. Masks are also challenging when kids are tired, hungry, upset or sick. In these instances, parents may want to consult with experts on ways to help their children adjust.

Preventing the Spread in Classes

For school systems and districts, health and safety risk reduction also means changes to current practices. To safely reopen, schools must allow for outside classes or proper ventilation, disinfect high-touch surfaces and keep smaller class sizes or cohorts

The DESE offers suggestions for ways schools can organize and operate to meet these requirements:

Desk Spacing

The DESE guidance suggests that children should do their schoolwork at desks spaced at least three feet apart, facing the same direction. Some parents and educators might be wondering why the desk spacing is suggested to be three feet apart, versus the six-foot rule.

Dr. Murray explains that the six-foot guide is a more conservative suggestion, especially when masks cannot be worn. In places like classrooms that have capacity limitations with existing buildings, three-feet apart is okay for a low-risk population wearing masks.

Ventilation

Outdoor settings reduce the risk because of airflow. When classes are inside, proper ventilation can help lower the risk. Schools' HVAC systems should be inspected and filters should be changed. However, ventilation is a less critical factor than the other measures: physically distancing, wearing masks and staying home when sick.

Best Practices Beyond the Classroom

As parents well know, the school experience comprises more than a day spent at a desk. Schools are encouraged to take additional steps to prevent the spread of COVID-19 in all aspects of student life.

On the bus, for example, best practices include: wearing masks, physical distancing, smaller cohorts and keeping windows open when possible. For physical education and recess, it is important to be outside when possible, limit the number of children and avoid sharing equipment. As always, physical distance and masks also help.

The cafeteria poses an extra challenge because when we eat, we remove our masks and bring our hands to our mouth. Physical distancing of at least six feet is crucial, plus smaller cohorts of people eating together and washing hands before and after eating.

"I think creative reuse of locations like we have done in the hospital and clinics for eating will also have to be done in the schools," says Dr. Murray.

How Parents Can Prepare

Parents should model health and safety behaviors at home. Families can practice wearing a mask and proper handwashing. Talk to your children about the upcoming changes to the school environment. Use simple words and bring familiar situations into the conversation. Children respond well to the word "safety" because they are used to following rules for crossing the street or wearing helmets and seatbelts.

"I would encourage families to really embrace all of these new safety measures so that their children can benefit from the great education we have here in Massachusetts," Dr. Murray says.

Expect Change

The guidelines will likely change as we learn more about the setting and risks. As we get more data, we can lower the risk and allocate resources more appropriately. Looking ahead, we will need protocols guided by evidence for when it is safe to do in-person vs. remote school.

With so much uncertainty, the decision to send a child to school can be difficult. The DESE guidelines were developed to help eliminate risk and keep students safe in their environments. If properly resourced, schools will be able to help minimize the spread of COVID-19 among students and teachers; parents who can model safe behavior and seek help where necessary can support these measures and help keep schools safe.

Additional Resources

• CDC School Reopening Guidelines
• SARS-CoV-2 pooled testing in schools