Experts recommend strict, costly approaches for reopening schools

The American Academy of Pediatrics recently highlighted the importance of students' returning to the classroom in its COVID-19 return-to-school guidance. Jason Wang, MD, PhD, of Stanford Health Policy also believes it's time for kids in the United States to get back to school. But he believes school districts could better protect their 55 million K-12 students by adhering to an additional set of strict measures.

"Prolonged school closures can exacerbate socioeconomic disparities, causing negative education and health outcomes, and amplifying existing educational inequalities," said Wang, a pediatrician and director of the Center for Policy, Outcomes and Prevention in the Stanford School of Medicine. "School closure may also aggravate food insecurity, domestic violence and mental health disorders. Many children from low-income households obtain food through the National School Lunch Program, and estimates suggest that 1 in 4 children may face hunger this year due to COVID-19."

But serious precautions must first be put into place, Wang said, starting with each school district establishing a COVID-19 task force composed of the superintendent, members of the school board, teachers, parents and health care professionals to develop policies and procedures.

"To implement and evaluate specific measures, the task force should create and oversee a command center for the school district, composed of data analysts and health experts who can liaise with the local health department," Wang writes in a JAMA Pediatrics article with co-author Henry Bair, a medical student at the Stanford School of Medicine who is also working on an MBA at the university's graduate school of business. The article will be published Aug. 11.

Three-pronged testing approach

The academy's guidance does not include ways schools can test for the virus, so the authors recommend that school districts collaborate with local hospitals to:

• Test all students with symptoms.
• Devise a schedule to randomly select a proportion of students and staffers for COVID-19 testing to identify asymptomatic individuals. The researchers note that a pooled testing strategy can significantly reduce costs.
• Offer more frequent testing to students from high-risk households in ZIP codes with socioeconomic challenges.

In addition, the authors recommend that district task forces:

• Work with its local health department to provide educational materials and training for students, parents and school staff on the basics of COVID-19 prevention.
• Provide school staff with thermometers and train them to screen for COVID-19 symptoms.
• Build temporary modular buildings if schools cannot maintain 6 feet of physical distance among students and teachers.
• Expand the district's fleet of school buses or develop different pickup schedules.
• Increase budgets to boost disinfection efforts of all teaching spaces, common areas and high-touch surfaces such as doorknobs, computers and desks.
• Place transparent plastic shields in front of and along the sides of student desks.
• Provide hand sanitizers and protective equipment, such as disposable surgical masks, reusable cloth masks or reusable face shields.

Wang concedes these are expensive measures. But as the Centers for Disease Control and Prevention noted in its July 24 telebriefing on new resources and tools to support opening schools: The 5.6 million parents who haven't been able to work due to school closures have collectively lost an estimated $232 billion in earnings.

Stricter measures mean bigger budgets

Some low-resource communities might find these guidelines difficult to adopt. Those transparent desk barriers, for example, range from $100 to $200 per desk; COVID-19 tests run between $50 and $200 per individual.

Wang said that's why additional federal funding and state subsidies are crucial for the low-income communities already hit by the double whammy of having more parents as essential workers and some of the highest hospitalization and fatality rates from the pandemic.

"Low-income communities are suffering most from shelter-in-place policies because parents who are essential workers are out of the home and not able to help with online learning," Wang said. "And many children in these communities also live in crowded conditions that are not conducive to learning at home."

Wang and Bair note the academy's guidelines emphasize the importance of identifying symptoms and signs of COVID-19, but don't go far enough in recommending operational approaches.

"To address this, we recommend that schools implement multilevel screening for students and staff," they write. Each morning parents should report any fever or COVID-19 symptoms to an online or an automated telephone-based program maintained by the school or district. Any students with symptoms should stay home.

Even with all the precautions in place, COVID-19 outbreaks within schools are still likely, the authors said. Schools should prepare for temporary closures and be ready to transition back to full-time online education by investing in remote education platforms and training.

"Schools will need to ensure equitable implementation of online education among students, especially those with limited knowledge of or access to technological resources and consider subsidizing educational technologies for these students," the authors write.