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Disclosures: The authors report no relevant financial disclosures.
May 07, 2020
4 min read
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AAP issues guidance on reopening schools

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Nathaniel Beers

The AAP issued guidance on the reopening of schools and said it will support “collaborative decision-making” between school districts and local and state public health departments about when they will be allowed to open again safely.

The AAP said the decision will be dependent on several factors, including the local and national epidemiology of SARS-CoV-2, the coronavirus that causes COVID-19, and the possibility that schools will need to be closed intermittently because of the virus. Other factors, as outlined by the AAP, include:

  • The availability of testing by commercial and academic entities and local and state public health departments; the capacity of state and local health departments to conduct community surveillance and contact tracing.
  • Implementation of measures to limit the spread of COVID-19 within the school setting, such as appropriate disinfectant and sanitizing procedures; screening, monitoring, and testing for illness among staff and students; use of masks; and limiting interactions of students — teachers moving in between classrooms rather than students.
  • Emerging data about the role that school-aged children and adolescents play in transmission of COVID-19.

Nathaniel Beers, MD, MPA, FAAP, a pediatrician at Children’s National Hospital in Washington, D.C., and co-author of the guidance, said the AAP is not recommending that schools open now, but when it is safe, these are the guidelines they should follow.

“I think the guidelines provide the opportunity for schools to think about the components that they should be working on together with their local and state health departments to make a determination about when is the right time for their school district to go back to school,” Beers told Healio.

“I think that we have become acutely aware as a society that schools are much more than just a site for education for students, and so as we think about the components of opening, we need to be considering [that] as well. Thinking about the educational needs, nutritional needs, as well as the specialized populations are important.”

The AAP noted that, while many school districts have implemented distance learning measures during the pandemic, “this is not generally believed to replicate the in-person learning experience” and not all children will have had equal access to this type of instruction. It said considerations should be made for students who may have experienced “educational loss” over the course of the pandemic. As explained by the AAP, other considerations include:

  • Education: Impacts of lost instructional time and social emotional development on children should be anticipated, and schools should be prepared to adjust their curriculum.
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  • Nutrition: According to the AAP, millions of American children depend on meals provided at school. School meals are likely to be a critical source of nutrition for children.
  • Disabilities: Students with disabilities may have more difficulty adjusting to social and emotional transitions back in the school setting. Schools should develop a plan to ensure an Individual Education Program review.
  • High-risk students: The risk to students with high-risk medical conditions, especially mechanical ventilation-dependent children or children with tracheostomies, should decide whether or not the student should continue online-based learning.
  • Annual school health requirements: School districts may consider limited extensions for families to submit annual paperwork required for start of school, to accommodate delays in accessing well child care during the public health emergency. To limit the risk for other vaccine-preventable diseases during this critical period, immunization compliance should continue to be prioritized.
  • Onsite health services: Collaboration with school nurses is essential, and all school districts should involve health service staff early in the planning stages of reopening.
  • Athletics: Preparation for sporting events, practices and conditioning sessions should be conducted in alignment with AAP’s Preparation Physical Evaluation Monograph.
  • Mental Health: School mental health professionals are critical in shaping messages to students and families about school re-entry, including addressing anxiety and social acclimation.

According to Beers, once schools are ready to reopen, they may consider changes to scheduling and the way that students and teacher move around.

“School districts are thinking about staggered scheduling,” Beers said, noting that schools may not want to have students from all grades attend on the same day. “How do people transition between classes? Do kids transition between classes, or do the adults transition to decrease some of the traffic in the hallways? This all has to be part of [what] schools think through.”

According to the AAP, other environmental considerations include:

  • Isolation measures: School districts should be prepared to follow public health guidance regarding exclusion and isolation protocols for sick children and staff identified at the time of arrival or throughout the school day. In the event of confirmed or suspected cases of COVID-19 among students or staff, schools should have in place guidance on appropriate cleaning and contingency plans for closing classrooms, schools or districts based on identified cases and in compliance with public health and CDC guidelines.
  • Group size: School districts should anticipate continued restrictions on physical distancing and group size, per the CDC and/or the local or state health department. Scheduling and staffing models must be prepared to accommodate having fewer students and staff in a given classroom or space.
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Beers said there has been debate among experts regarding the correct recommendations for students wearing masks.

“I think there is a lot of debate going on around whether every child should be in a mask, and how young. Certainly, we're not recommending masking for children under age 2,” he said. “There are children, for variety of reasons, who should not necessarily be in masks. Masking may create situations where kids are fiddling with their faces more than they would otherwise.”

The AAP said that until the broad availability of a vaccine or treatment for COVID-19 exists, there is a risk for future waves of COVID-19. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.