As schools start virtually, the question of how to open in person still looms
Compared to some states, Maryland has succeeded in “flattening the curve” of COVID-19 cases. Hospitals have not been overwhelmed, and transmission has been relatively stable, without huge surges indicating uncontrolled spread. Our statewide rate of new cases is now in the ballpark of the 10 per 100,000 population, less than the 15 per 100,000 population benchmark Gov. Larry Hogan is using as guidance to declare schools should open up at least for hybrid learning.
Unfortunately, the local rates in our state vary substantially, from less than one case per100,000 in Garrett County to a high of 21 per100,000 in Worcester County on Sept. 7. Baltimore city and county are above 10 cases per 100,000 and rising in recent days. There’s more work to be done to be ready to open all schools in Maryland for in-person learning.
The American Academy of Pediatrics has strongly advocated for a return of children to the classroom. For the majority of children, the benefits of school for children outweighs their individual risk of becoming seriously ill from COVID-19. Children need school not only for learning, but also for socialization, development, nutrition, structure and protection (schools report child abuse more often than any other source). Working parents clearly need help with daytime care for their children — and few can successfully monitor at-home schooling while working. The pressures for children to return to school are enormous from an equity standpoint as well: Underserved populations with poor internet access and two working parents are going to be at high risk for school failure in a remote setting.
The challenge is balancing the urgency of returning children to the classroom with the threat of the pandemic. Children clearly are able to catch and transmit COVID-19, and recent data suggests that as many as nine in 10 children won’t show symptoms but can still pass along the disease. Sending children back to school raises the risk of greater community transmission.
As was seen in Israel, when schools opened before community transmission was under control, it took only 10 days for a large scale outbreak to occur in a high school. Similar outbreaks occurred in France and Chile when schools opened while the community transmission rate was still high. The risk is significantly lower when the community rate is low, like in Ireland, or when adequate precautions to prevent transmission are taken, like child care centers in Rhode Island.
There is no easy or right answer, but there are best practices to limit the transmission. What is needed is a comprehensive plan with clear benchmarks and guidance to minimize the spread of the infection and protect those who are most vulnerable while allowing for the majority of children to return to school.
The measures that we recommend
follow the guidance of the American Academy of Pediatrics and it starts with community control of the disease. Many experts believe that unless new cases are at least in the range of five to 10 cases per 100,000 and stable, the chances of success are slim. This means we may need to hold on opening parts of the economy until we can lower transmission rates enough to open school. Once in this range, key precautions need to be taken. These include:
■ Focus on elementary schools first: Children under10 are much less likely to spread the disease than teenagers.
■ Create adequate space and limited class sizes in order to maintain at least 3 feet (if not 6) of physical distancing in the classroom and hallways.
■ Cohort classes and move teachers around rather than students to minimize the number of contacts each child has.
■ Mandate facial coverings for all students, staff and teachers.
■ Allow for flexibility in start times to minimize the number of children on a bus, not have every student arrive at the same time or have lunch at the same time.
■ Create flexible and nimble educational plans that allow the same quality education for children who have to be remote (either by choice or because they are being quarantined) or if community spread increases to a point where schools need to close.
Allow teachers with high-risk conditions to do remote teaching, while younger and
healthier teachers return to the classroom. They must be provided appropriate personal protective equipment and facilities.
Configure the school facilities to allow for adequate space and ventilation. Given the fact that dozens of schools alone in Baltimore City and Baltimore County can’t even be open when the temperature is 90 degrees, this will be a major obstacle.
These steps will cost real money, far more than Governor Hogan is currently offering. It is critical for the state and federal government to prioritize children by giving their schools critical resources for reopening.
There’s a clear reason to do so: The entire state will benefit by focusing on safely opening schools. Businesses will have employees who can work and be more productive. Children can learn, see their friends and begin to recover what they have lost. And we can start to return to a sense of normalcy. We must fully invest in all the steps needed to keep children, teachers, parents and the community safe.
Dr. Scott Krugman (Skrugman@ lifebridgehealth.org) is vice chair of the department of pediatrics at the Herman and Walter Samuelson Children’s Hospital at Sinai Hospital in Baltimore. Dr. Joshua Sharfstein ( joshua.sharfstein@jhu.edu) is a pediatrician and professor of the practice at the Johns Hopkins Bloomberg School of Public Health. This article reflects Mr. Sharfstein’s views and not necessarily the views of Johns Hopkins.