School must look much different this fall to keep kids safe, says pediatrician

Editor’s Note: Dr. Tanya Altmann is a pediatrician, spokesperson for the American Academy of Pediatrics, school physician at Viewpoint School in Southern California and mom of three school-age boys.

Because Covid-19 scientific and medical information changes frequently, our nation is going to need adaptable guidelines to safely ring the school bell this fall.

As I see it, we need to solve three problems.

First, we need strategies to keep this particular coronavirus from entering campuses nationwide. Second, we need measures to decrease person-to-person transmission. Third, we need to quickly test, diagnose, isolate and contact trace when needed.

Although school districts will be looking to the American Academy of Pediatrics (AAP) guidelines released today and earlier guidance from the US Centers for Disease Control and Prevention, different considerations must be made for each school in collaboration with local and state public health departments on when it is safe to reopen and bring children back on campuses across the country.

It’s important for parents to know that child health is a priority, and that is why the AAP continues to emphasize the importance of school physicals including any needed vaccines for your child prior to the first day of school to help prevent an outbreak of other preventable infectious disease such as pertussis (whooping cough) or measles.

Kids and parents know that most viruses, including this new coronavirus, spread mainly person-to-person when in close contact. When an infected person coughs, sneezes or talks, microscopic respiratory droplets are produced and can land in the mouths or noses of those nearby – or possibly be inhaled into the lungs.

These invisible virus particles also land on surfaces, and if touched by another person who then touches the eyes, nose, or mouth, can cause infection. As we know, not everyone with Covid-19 has symptoms, so the virus can even be spread asymptomatically.

How to keep an invisible virus out of school

How do you keep an invisible virus from entering a schoolyard or classroom? Creating a school environment that supports social distancing will help – staggering start times, staggering academic days, limiting volunteers and visitors on campus.

Screening is also necessary – every morning by a parent at home or upon arrival, with questionnaires, temperature checks, or even Covid-19 surveillance testing.

Once students are on campus, we decrease transmission by “de-densifying,” limiting activities where large groups of students are in close proximity. Ideally, students will be grouped into smaller classes, remain in the same desk or room as much as possible, and teachers or specialists will rotate class to class to minimize movement of students around campus.

Virtual assemblies and library time

Assemblies and even library time can be virtual. Librarians can read a virtual book and show students options that can be delivered to class for students to take home and read. Lunches will be eaten in class or with social distancing, and playground structures may close, with an emphasis on non-touch sports and recess.

Kids can still run and kick a soccer ball with their own class, but recess time may be staggered between classes to limit the number of students on the school yard. Schools may also limit the items kids can touch, such playground equipment (or thoroughly clean equipment between each class).

This will be a “new normal” school day, and it will take some time for students, teachers and families to adapt. But kids are resilient, and they will still learn and socialize in as safe as an environment as possible. And it’s important to note that this isn’t forever.

Of course, hygiene measures such as frequent handwashing breaks prior to entering class, before lunch, after using bathroom and upon exiting classrooms will be key. Schools may plan for one-way traffic flow through campus as needed. Schools will need to be cleaned or defogged every evening and all surfaces disinfected thoroughly and frequently.

Will students wear masks?

Then there is the great mask debate, as masks do play an important role in decreasing transmission of the virus, especially since Covid-19 can be acquired through asymptomatic transmission.

Having young elementary school kids wear masks though can pose its own issues as young kids tend to touch their face more when they wear masks and lack skills to properly put masks on and take off.

For middle school and high school students, teachers and school staff, wearing face masks will play an important role in decreasing transmission. In the younger grades, educators can be masked to protect the student and themselves.

There may be a way to educate younger elementary students on proper mask wearing, but for preschool and kindergarten, I’m not sure it’s feasible. We will need to rely on frequent hand washing, social distancing and the usual education on covering coughs and sneezes for the youngest students.

Despite these best practices, at some point, somebody will get Covid-19. How we test, diagnose, isolate and contact trace will be critical to decrease transmission of infection to others.

Isolating Covid-19 patients

Schools may need an isolation room where a child can wait for parent pick up. School nurses and administrators whose role it is to have contact with such students should be provided appropriate personal protective equipment.

Similar to pertussis and other infectious disease outbreaks, schools will need protocols in place when sick kids, or those with mild cough and runny nose as many students have all winter, can return to school. Such guidelines may include a negative Covid-19 test, 3 days without fever and other specific symptoms before returning to school.

When a student is identified as having Covid-19, measures will be in place, similar to lice notes sent home letting parents know that a child may have been exposed. And at what point is an entire class quarantined, an entire grade, or the entire school? If classes are truly kept separate from other classes, this will decrease the need to send home entire grades or close an entire school.

Children will need access to online learning

When kids are sent home to quarantine – or for vulnerable children whose parents don’t feel comfortable sending them to school – virtual or on-line school options will need to be available so teachers and schools may be taxed with running in person and on-line school simultaneously.

Schools will need to work with local pediatricians and health clinics to help quickly evaluate and test children when needed. In addition, school families and students can help by sewing masks or even produce 3D printing face shields.

Local public health departments will also play an important role in helping schools test, isolate and contact trace to keep Covid-19 cases at a minimum and prevent outbreaks.

Of course, options will vary from school to school based on the number of students, size of the campus and flexibility of families to adapt to new schedules and routines. Sadly, Covid-19 and the resulting education gap will afflict schools disproportionately in dense urban centers with socioeconomic disparity.

This is where creativity and innovation come into play.

Teachers, administrators and even older students are very good at problem solving such issues, and I look forward to seeing what they have to say and how they continue to solve the problem at hand – to keep kids healthy, safe and learning.