covid-19

How to Keep Schools Open during the Pandemic

Limiting in-school COVID spread is critical for limiting transmission in the surrounding communities, write Laura White, professor of biostatistics, and Eleanor Murray, assistant professor of epidemiology, in a new commentary.

How to keep schools open safely remains one of the most challenging and controversial issues of the COVID-19 pandemic. As the federal government, states, and cities reverse course on universal school mask mandates, people continue to debate and compare the risk of in-person disease transmission in schools to the negative social and mental health impacts of facial coverings and other mitigation measures.

Framing the question of school safety in this way creates what appears to be an impossible dilemma “centered around numerous false dichotomies,” write School of Public Health researchers Laura White and Eleanor Murray, in a new commentary published in the journal Cell Reports Medicine.

“Roughly half of the United States population is in school, works in a school, or is a first-degree contact of individuals in the previous two categories,” write White, professor of biostatistics; Murray, assistant professor of epidemiology; and Arijit Chakravarty, CEO of Fractal Therapeutics. “It is not surprising that there are real-world data consistent with the possibility that in-school transmission can impact the disease burden in surrounding communities.” However, “there is evidence that schools can operate successfully without significant in-school transmission when appropriate mitigation strategies are employed.”

In the commentary, White and Murray identify limitations in research that have minimized the true extent of COVID transmission in schools, and they provide evidence of school-based transmission and its impact on community spread. They also present strategies on how to minimize the potential for schools to drive disease transmission and ensure the safety of students, staff, and surrounding communities.

High-quality filtration systems, surveillance testing, and a contingency plan for a potential return to remote learning amid a future surge of COVID cases in the community are all critical measures that schools should implement, White and Murray write. Removing mitigation measures such as temperature checks and excessive surface cleaning that have proven to be ineffective is just as important, they add.

“These mitigation measures become ‘hygiene theater’ in that they provide false reassurance that interventions are in place while also being ineffective at preventing spread and contributing to ‘pandemic fatigue’—declining trust in and energy for pandemic mitigations,” the authors write. “Guidelines need to be updated and communicated as technologies are developed and science progresses.”

Notably, the authors point out that high-quality, well-fitting masks act as a “second layer of defense” after appropriate ventilation. The commentary was published shortly before the Centers for Disease Control and Prevention announced new recommendations on indoor mask-wearing for communities with low or medium COVID levels. Instead of primarily focusing on case counts, the new metrics for COVID community levels also rely on COVID hospitalizations and hospital capacity—which means that more than 90 percent of US residents are now in a county with low or medium COVID levels.

White says she is concerned that these new guidelines will introduce mitigation measures much too late in a COVID surge.

“A goal of surveillance should be early detection for the prevention of transmission and disease,” says White. “Unfortunately, hospitals are a lagging indicator of increased COVID transmission in the community. We have observed that by the time we see a spike in hospitalizations, community transmission is widespread. I would favor more surveillance testing—and schools provide a great place to do that—for early detection of COVID activity in a community.”

Click here to read the full commentary.