COVID-19: School Reopening Guidelines

Introduction

We at EHA believe opening schools is both safe and possible during the COVID-19 pandemic. Current data supports in-person learning and does not identify in-person learning as a driving factor behind the spread of this disease. There are however aspects of distance learning that can negatively impact the student. Distance learning for K-8 can disproportionately affect marginalized groups without access to laptops, tablets and high-speed internet, even in major cities.

The U.S. Department of Agriculture has approved schools to provide meals to students during distance learning until December 31, 2020. Fewer and fewer children who are eligible for free or low-cost school meals have trouble accessing them because of transportation issues.

Coupled with the stress of staying focused during distance learning sessions, hunger is an added burden. Lastly children are required to have immunizations at scheduled times. When students are not present in school, they miss this check-and-balance. The following document was written in an effort to open schools safely and reduce the risk of disease transmission, specifically novel Coronavirus SARS-CoV-2 and the disease it causes, COVID-19.

Risk Reduction Strategies for Schools

According to studies conducted by Brown University School of Public Health, the latest details on infection control sources show schools are not a primary driver in spreading COVID-19. Keeping robust infection prevention strategies in place has been shown to be very effective.

> The Case for Open Schools in a Pandemic

In a school environment, it is nearly impossible to assure students and staff a zero percent probability of contracting COVID-19 while at school. However, with the proper implementation of classroom, building and health policies, the risk can be greatly reduced. Below we present strategies to reduce the risk of infection to students attending school K-12. As we have explained above, this is a respiratory disease. We must educate children on proper and consistent face coverings and they should comply with, and understand, the importance of wearing a mask.

Hand Hygiene and Face Masks

Students must wear a face mask which always covers the mouth and nose, except while eating. They must be taught to adjust the mask from the sides and not touch the front. Secondly, promoting good hand hygiene practices is simple and an effective preventative measure for COVID-19. Students and faculty should be shown how to properly wash their hands as well as the most opportune times to handwash.

For example, handwashing prior to eating, touching shared objects, and touching your face should be made a priority. When handwashing is not possible, hand sanitizer that contains at least 60% alcohol may be used as an effective alternative, however hand sanitizer should not replace handwashing. Schools can take this a step further and incorporate handwashing periods into their daily schedule.

Social distancing is very important inside and outside the classroom. We know SARS-COV-2 is largely transmitted through close person-to-person contact. According to the CDC, “Infections occur mainly through exposure to respiratory droplets when a person is in close contact with someone who has COVID-19. The classroom desks should be separated at least six feet apart while also implementing assigned seating.

Desks should be arranged in a manner where they are all facing the same direction and not having students facing each other. Outside of the classroom, use tape or directional marks to prevent bi-directional foot traffic. Use tape on the floor to indicate where students should walk or stand so they maintain a six-foot distance. This also means places like entering and exiting the building.

Cohort Classrooms

Establishing classroom cohorts will help minimize the potential for a widespread outbreak of COVID-19 in a school. If a student or faculty member within a cohort tests positive for COVID-19, the number of close contacts becomes much smaller, in turn the spread is decreased. Classrooms should only interact with another class or two, instead of all students within the school being able to interact with each other. This is useful for younger students in elementary school who typically spend most of their day in one classroom. This method is not as practical for students in middle or high school who may switch between classes and classrooms throughout the day. A cohort can still be created by rotating the same group of students between the same classes and classrooms.

Cleaning Surfaces and Correct Use of Disinfectants

SARS-COV-2 can contaminate surfaces via respiratory droplets from an infected person landing on an object. The virus has the ability to survive on certain surfaces for typically three days under normal conditions. Consequently, an emphasis should be placed on cleaning and disinfecting shared objects and high-touch areas throughout the school.

Shared objects consist of books, pencils, electronics, and art supplies; while high-touch areas include door handles, light switches and sink handles. Use EPA registered disinfectants effective against Coronaviruses. Do not use glass cleaner or other all-purpose cleaners. Allow the surface to dry according to the dwell time listed on the label, typically this is anywhere between 2-5 minutes but sometimes longer.

> List N: Disinfectants for Coronavirus (COVID-19)

Buildings: Increase Ventilation and Improve Filtration

Filtering air is one of the most critical things a school can do. For those older schools without forced air, keeping the windows open will be helpful. If they are equipped with air filters, they should update them, so they meet MERV-13 (Minimum Efficiency Reporting Value) requirements or equivalent. At this level your filter will capture not only dust but even tobacco smoke, pollen, bacteria and of course viruses. HEPA filters are one such example. Portable HEPA filters for the classroom is also recommended. Filters should be changed according to the manufacturer.

The SARS-COV-2 virus is about .125 µm (microns). To put this into perspective, one grain of sand is 90 µm in diameter. To achieve MERV-13 your filter must catch 90% of particles in the 3-10 µm range, 90% of particles in the 1-3 µm range and 50% of particles in the 0.3-1 µm range.

Plexiglass Barriers

Barriers can block respiratory droplets produced by a person who is in close contact with the barrier. A good example are Plexiglass shields which allow people to stay close while supporting physical distancing. Barriers are appropriate in a variety of settings, including lunch areas, classroom settings and spaces where it is difficult to maintain 6 feet of separation between individuals. Plexiglass barriers are nonporous and may be disinfected. Ultimately, they provide a sense of security and assurance for students, parents and teachers.

Policies

Create a COVID Response Team

A COVID response team should be composed of very competent people (or a person) with a strong foundation of topics such as Epidemiology, Microbiology, risk mitigation, emergency management and public health. They do not need to be nurses or caregivers, but they should have a thorough understanding of COVID-19. They will be tasked with implementing and sending COVID-19 policies as they relate to past and present information available. The person(s) should have contact tracing training which is available free online.

Infection Control is a Shared Responsibility

The COVID response team cannot be the sole person responsible for the mitigation of COVID-19. This is a joint effort between stakeholders at every level. Temperature checks and screening at the visitors’ office, reminders in the bathroom to wash your hands and signage throughout the building to stay six feet apart are examples. Training should be provided for all teachers, staff and students before school opens.

The school should have in place social distance markings created by an appropriate department (think school branding). Regular meetings should be conducted to evaluate how these policies are followed and if they are in line with current local guidelines.

Cleaning Practices and Cleaning Schedules

Creating a culture for health and safety within a school is extremely important during this COVID-19 pandemic. A well outlined cleaning schedule with detailed cleaning practices is integral to creating that culture. Cleaning schedules will assist custodial and janitorial staff to properly sanitize and disinfect at the correct frequencies. High-touch contact areas should be disinfected multiple times throughout the day; however a desk or chair may only need to be disinfected once. Along with the cleaning schedule, providing staff with proper cleaning practices is also necessary.


COVID-19 Question Screening: Y/N
Have you had COVID-19 symptoms in the past 14 days? Fever or Chills, Cough, Shortness of Breath or Difficulty Breathing, Fatigue, Muscle or Body Aches, Headache, New Loss of Taste or Smell, Sore Throat, Congestion or Runny Nose, Nausea or Vomiting, or Diarrhea.
Have you had a positive COVID-19 diagnostic test in the past 14 days?
Have you had close contact with a confirmed or suspected COVID-19 case in the past 14 days?
Have you traveled within a state with significant community spread of COVID-19 for longer than 24 hours within the past 14 days?

Schedules

Stagger schedules, especially during peak times like the beginning and end of the school day and lunch. Limit gatherings whenever possible. Instead of in-person meetings use Skype, Microsoft Teams or Zoom. These are great examples of web-based teleconferencing which can be done between teachers and parents.

Consider closing non-essential areas where students gather in high-touch areas like library rooms or areas with vending machines. Reducing interpersonal activity among students is not advised, but if it interferes with social distancing it is recommended. Only students and teachers which are needed should be present. Adjust classroom hours to keep students separated. Setup an A/B schedule to stagger students’ schedules.

Transportation

The way students travel to school will change. Each bus should reduce ridership to maximize efforts to socially distance, if possible. As weather permits, the windows should be opened to circulate the air. Multiple buses should be used to facilitate social distancing. In addition to staying apart and segregating seats, the students must keep their face coverings on. If the start and stop times of school could change, this would allow students to take other forms of public transportation. Encourage parents to take their kids to school or carpool in small cohorts. For those students that live close to school they should ride a bike or walk.

Music and Sports

Play sports, especially outside. Outdoor activities should remain in place. Every type of sport carries some degree of risk. There is a great amount of psychological and physical evidence that supports the need to participate in sports.

Depending on the sport, there are ways to keep far apart during practice sessions that would not otherwise be done during practice. Many sports can be done outside or inside, weather permitting (e.g. basketball). Mask use, physical distancing and handwashing should be closely monitored by the coach. Like in the classroom, the coach should emphasize the importance of the rules in place. Some flexibility exists, such as using alternative fabrics, if needed, which still are CDC approved. Avoid sharing equipment (e.g. baseball bats) but sometimes this is impossible (e.g. basketball).

Typical post-game activities like high fives and team huddles should be avoided. Any in-person meetings should take place remotely, outdoors, or in situations where physical distancing can be maintained. Workouts, practices, and drills could be completed.

Activities like playing musical instruments should be reconsidered, especially for wind and brass instruments. String instruments and percussion pose little risk, provided they are not also singing. Playing musical instruments is also an activity that can be done outside to some extent. Lastly, playing an instrument can be suspended to study music history, theory or production.

Conclusion

The driving factor behind the community spread of COVID-19 is not related to opening schools, or any schools for that matter. With this in mind, we believe schools should reopen under very careful guidelines. These basic guidelines include social distancing, consistent use of masks over the mouth and nose and good personal hygiene. When applied to your organization, you will find much more can be done - including staggering schedules, closely monitoring visitors for signs and symptoms, adjusting the way students get to school and improving ventilation. As best practices develop throughout the year, we will continue to update this paper.

References

New Information on SARS-COV-2

A new study by Australia's National Science Agency reports SARS-COV-2 can survive for 28 days in the dark. Previous studies showed SARS-COV-2 would survive 2-3 days on smooth surfaces like glass and plastic. It is still debatable how infectious this mode of transmission is since this is a respiratory disease.

Coughing, sneezing, singing and even talking are the most common transmission routes. These floating particles can be infectious for up to three hours. This means when a student moves from place to place, and the surfaces are wiped down, it may not be relevant.