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Health Experts: Masks, Distancing Key To Preventing COVID-19 Outbreaks In Schools

Des Moines Public Schools custodian Cynthia Adams cleans a desk in a classroom at Brubaker Elementary School, Wednesday, July 8, 2020, in Des Moines, Iowa.

As schools across Illinois finalize their plans to reopen this fall, the Champaign-Urbana Public Health District is urging students, teachers and school staff members to wear masks at all times and stay at least six feet apart. The C-UPHD recently released guidelines and recommendations for schools and families as they prepare to begin the next school year amid the ongoing COVID-19 pandemic. The guidance comes after both the Urbana and Champaign school districts announced their reopening plans, which each include all-remote online options for students, as well as some in-person instruction. 

Illinois Newsroom recently spoke with C-UPHD Administrator Julie Pryde about the guidance and best practices to prevent outbreaks of COVID-19 in the classroom.

Lee Gaines: As a public health administrator, how do you want schools to reopen? And do you want schools to reopen for in-person instruction at all?

Julie Pryde: As a public health person, we lean toward the safest always. But we realize that it’s easy for us to put out guidance, but operationalizing it is a lot more difficult. The schools have to look at what their families’ situations are and what type of staff they have. There’s all kinds of things to look at. So our main goal is for schools to have options, so that people, families, teachers, staff, everyone can look at our guidance and take a look at the risk of COVID spread within their school setting. Plans can look great on paper, but how is it working at each site? So people need to be able to look at that and then look at the information on their own personal risk factors like: are the children at risk for a more negative outcome, or the teachers, or somebody living in their homes? We tried to put (the guidance) together in a way that everyone could understand it, and then everyone could make the best decision possible for their individual situation.

Could you describe each one of these scenarios moving from no risk to highest risk for school reopening?

No risk would be students and teachers engaging only in online virtual classes, activities and events. So there would be no in-person contact.

A minimal risk would be a combination of virtual and small in-person classes, activities and events. The students and teachers with underlying health conditions are not physically in the school. And they’re maintaining social distancing and masking at all times. Activities that take place outdoors are generally safer than indoors. Of course, we’re living in Illinois, so that can only happen so much.

Moderate risk would be small to medium in-person classes. The groups of students stay together and with the same teacher throughout and across school days. We call that cohorting. So it’s the same group always together and they do not mix with other groups. So this would be a group coming in, sitting down at their desks and pretty much not leaving, and the teacher remains the same. Children remain the same, they remain seated six feet apart and wearing face coverings at all times and they do not share objects. That’s still moderate risk.

And then high risk, of course, would be just basically going back to normal. That would be a disaster. That would be full size in-person classes, activities and events. Students are not spaced apart, they’re not masked. They share common classroom materials or supplies, and they mix between classes and activities. Highest risk is basically like school was before the pandemic.

I think that the big issue families and school officials and teachers are struggling with right now is how to balance the risks to their health and the public’s health, and then the risks to student learning and social emotional development. Then there are families who are returning to work and they need childcare.  And then there are also families with children with special needs, who need extra support that’s typically only provided in an in-person setting. What’s your advice to both school officials, teachers, families weighing these competing concerns?

Yes. And that’s why we did the guidance like this because that’s exactly the kind of things that you need to look at. There are kids that just need to be in school for a variety of reasons and then there are kids who can be at home, they can learn fine at home, their parents have enough resources. So that’s why we really wanted to have the schools provide options for families. The key to having the classes safely happen in school is going to be keeping kids at a minimum of six feet away from each other the entire time they’re in the building.

So you’re never going to be able to prevent a case coming into a school just like you can’t prevent a case from coming into a workplace or a long term care facility or even the Champaign-Urbana Public Health District. You cannot prevent them from coming in there. What you can do by having very tight infection control practices, specifically distance and masking, is you can prevent an outbreak in that setting. But when you have situations where kids are sitting too closely together, or they’re interacting a lot, we’re going to see outbreaks. So we want to get ahead of this, and make it clear to everyone that that’s what it’s going to take. So it can happen, it can happen safely in schools for sure, but it will require wearing masks all the time and remaining at a minimum of six feet from each other. 

And masks are not a substitute for social distancing?

No, they are not. This is a really important point that I need to make in case it’s been lost. And it has been lost on a lot of people. When you’re inside of a building, you’re going to need to have on a mask and the six foot distance at all times, because what is considered a close contact or an exposure is being within six feet of someone for at least 15 minutes. So, clearly, if a kid has COVID, and they are sitting within three feet of each other, whether they’re masked or not, those kids around that case are going to have to be quarantined. That means they’ll be excluded from school, and they will have to remain at home for 14 days. 

So you have to think about that. You have to think about them throughout the school day and ways to prevent them from getting in close contact with each other.

Who are the students and teachers who you believe should definitely not return to school this fall? 

I can tell you that the people who are at increased risk are people who are over 65, people with any of the following conditions: cancer, chronic kidney disease, chronic obstructive pulmonary disease, they’re immunocompromised, either by a disease or by medications, people who have had transplants. And this is one that people don’t think about: obesity. So if you have a (body mass index) of 30 or higher, you are at an increased risk of serious health concerns. People with serious heart conditions, sickle cell disease, Type 2 diabetes —  those all put people at more risk. Other ones would be children who are medically complex. They may have neurological or genetic or metabolic conditions, congenital heart disease. Then, people might want to consider and talk to their health care provider about asthma. 

It’s a lot of conditions, and that’s why it’s so good to be able to have options and then look at what your school’s plan is and see if they’re doing it in such a way that you can be protected there, or if you need to go to an online learning environment.

And this also includes people who live in the same household as someone with these conditions?

That is also a concern. There are certainly adults with these conditions. And then there are children with some of these conditions. And then there are also people living in the household, and we have a lot of families with multi-generational households, so their grandparents may be living with them, other relatives, and even parents with some of these conditions. So, that’s why it’s so complicated. It’s so complicated for the schools. It’s so complicated for Public Health. It’s so complicated for the families. There’s just not one one good answer. If we could just tell everyone to stay home all the time and do school there, of course we would do that. But that’s not taking everyone into account, either. Because there are kids that really, really need to be in school for a variety of reasons. They learn better there. The structure is really helpful for them. Some kids need the food, they need the support of the teachers. People need to realize that not everyone comes from a household that’s just like their own. And I’m always reminding people that we really need to understand that we are talking about a complete spectrum of situations and that’s why there just isn’t an easy answer. 

How should schools conduct symptom checks? 

One of the things that a lot of the symptom checks include is a temperature check. And you know, you can talk to any school nurse or any school secretary or really any parent and you know that kids have been sent to school for generations with having an aspirin or fever reducer. And normally that might be okay, but with (COVID-19) it’s not, because they can be infectious for even up to two days prior (to displaying symptoms). Symptom checks are certainly not foolproof. You have to assume that everyone in that school is infectious. Everyone on the bus is infectious. Everyone everywhere that you’re dealing with is infectious, including yourself. And that’s why we have to really embrace the masking and the distancing. Because that is really the only way that we’re going to be able to do anything inside this winter without having outbreaks.

How should they be cleaning the buildings? 

Schools do a lot of cleaning in general.  They’re usually cleaning for things that are more hardy, let’s say, then a virus to begin with. Really, a lot of this is just going to get down to hand washing. So rather than worrying about every little surface in the school, what we need to focus on is that kids are not sharing items, and that they are washing their hands. I know a lot of the schools have it set up so when the kids come in, they can either wash their hands immediately or sanitize their hands as they come into the room. So that’s great. You’re starting out with clean hands. You go to your own desk, you only touch your own things, and then wash your hands on the way out. That to me would be a really good plan, and lots of schools are doing that. That’s one way to do it. There’s all kinds of ways to do this. And it’s so complicated because we’re talking about kids from kindergarten all the way up to seniors in high school. There just isn’t a simple, easy, hey, let’s do this, and this is going to work. Because, you know, you have kids that may be in high school that put things in their mouth, and you have kindergartners who may not. It’s literally all over the place.

Kids get sick all the time. What should schools do if a student displays symptoms that could be COVID-19, like a fever, while they’re in class?

Any kid who gets sick with any symptom — or teacher or staff —  they are to be immediately isolated and then sent home. They need to go home and then Public Health will guide from there. The problem with this virus is that you are infectious up to two days before you show any symptoms at all. So that makes it so imperative that we do the masking and the distancing all the time whether people seem like they’re feeling well or not, it really doesn’t matter with this virus. We should see, with all this extra masking and distancing, we should see a lot less of every single kind of illness in the schools this year, which will be nice.

And then what if a child wakes up with a fever or a cough? What should they do?

They should stay home. Anyone who wakes up with symptoms or anyone who has symptoms at any time, please go get yourself tested. Don’t wait. Just go get tested immediately. And we will then go from there. But if someone has symptoms, even if they test negative, they need to stay at home, because there is still a 20% false negative rate with these tests. False positives aren’t the issue. It’s false negatives. So that’s why we can’t put someone in quarantine, give them a test and say, ‘oh, you’re negative, you can come out.’ Nope, you have to stay there for 14 days because that’s how long you could be developing this.

What if a teacher or a student tests positive for the virus — what should schools do then? 

How this works is: anyone who tests positive, Public Health gets that — no matter where they test. They could be in another state on vacation, test positive, and we’re going to know about it before they get back. So then we immediately work with the family and the schools and tell them where to go from there, so that they don’t have to worry about that all the time, because we’re going to be guiding them. We have ample contact tracers at our health department. We’re hiring more all the time. And we are going to be ready for our piece of this. So we’ll be doing the contact tracing and talking with the families. I need to let parents know, too, that if your kids are under 18, we will be contacting the parent or if we have only the phone number for the child because that’s what they listed on the form when they tested, then we will contact them and then ask to speak with their parents. We have a lot of ability to do the contact tracing and the follow-up. And we are going to have at least one full time dedicated staff (member) whose only job is going to be working with the schools on cases.

At what point should schools close for in-person instruction? 

Schools can make that decision at any point. But if you’re talking about Public Health, our state has done a really good job with metrics and making decisions based upon the data. And it’s out there for everyone who’s interested to look at. If you go to our website… you will see the specific metrics and what we are concerned about. At any point, the governor, Illinois Department of Public Health, based on state metrics, could shut down the entire state basically, and the same thing with our region. But what we’re looking at, for example, at C-U Public Health District, we’re looking at things like new cases per 100,000. So that’s the case rate, (also) number of deaths, test positivity (out of total) tests performed. We do a ton of tests because we have great access here. We’re also looking at COVID-like illness emergency room visits, we’re looking at the number of COVID-like illness admissions to the hospital. We’re looking at cluster percentage of cases. And we’re looking at (intensive care unit) availability. 

Locally, what we’re really focusing on is the test positivity rate, because we have a ton of testing going on, which is good because the testing is a public health tool that helps us shut down outbreaks. That’s really the point of testing in this type of situation. So, if we start creeping up toward an 8% positivity test rate, I can tell you that we will be very concerned. We will be out there long before it ever gets up to 8% sounding the alarm. Right now we’re at 1.9%. We always keep our data updated now, every morning at 8 a.m. We have an evening shift now doing contact tracing so people can expect, if they’re waiting for results, possibly getting phone calls from Public Health in the evenings as well. So please answer your phone. That helps us out a lot and helps the whole situation out.

As we’re seeing schools across the state releasing their reopening plans, I’m wondering what you’re most worried about?

I’ve definitely heard that there are schools that are going back that are not interested in, as they say, in doing masking, whether it’s a private school or whatever. That’s not in Champaign County, but there are definitely schools that are thinking about that. And it’s horrifying to me because there will be outbreaks and there is a very good likelihood that people will die from that. This is not a virus to mess with. This is not a virus to take chances with. I can tell you right now that states like Florida, Texas —  all these states that are just basically on fire with virus right now —  no way should schools be opening in that situation. Those states should be completely shut down. This is what’s so frustrating to me. This is not something new or magical that we’re just kind of making it up as we go. Public Health people know how to shut down epidemics and pandemics, but it requires a lot to do it. It requires leadership. It basically requires a situation that the US is not in right now. I never in my life thought I would see something like this. It’s very concerning. When you have people that won’t do a simple thing, like wearing masks to protect other people, or stay six feet away from people — it’s horrifying to me. I’m extremely grateful to be in Illinois because we are doing metric-based decisions at the state level. I’m worried about some places, even some places in Illinois. I am concerned.

If schools and parents can take away one thing from this guidance, what do you want it to be? 

What I want people to take away from this is that everyone in this county is really trying to do this safely. The schools, Public Health, cities, you know, everybody is really trying to get this right. But ultimately, it’s an individual’s, families’ decision on what they are comfortable with, what level of risk that they feel they are in. So that’s why we put it out in such a way that people can look at this and, and then look at what their schools are doing, look at their own personal situation and then make decisions based upon that.

Please try to have patience and be kind with the school administrators, the teachers, the families. It is a very tough situation. Understand that they are trying to make decisions that take so many things into account. And it is not an easy thing to do. Just because I would be comfortable keeping my kids at home and feeling fine that they would be able to learn at home — that doesn’t mean everybody else can do that. That doesn’t mean that people don’t need their children in school for a variety of reasons. Options are the key, I think, to making this as safe as possible and to make families, teachers and staff as comfortable as possible as well.

Follow Lee Gaines on Twitter: @LeeVGaines

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