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In March of this year, many schools transitioned from in-person to remote learning in response to the growing COVID-19 pandemic. In May, the CDC issued recommendations on ways schools can help protect students, teachers, administrators, and staff and slow the spread of COVID-19. Now, the AAP has issued guidance to support the creation of policies for school re-entry that protect the health of children, staff, and communities. The guidelines stress the educational, psychological, medical, and nutritional risks to children if they are not returned to the classroom, but acknowledge that our knowledge of how SARS-CoV-2 is transmitted is evolving.
Hygiene: Encourage frequent handwashing, decrease the use of common touch surfaces (e.g., by leaving doors open), and enhance routine cleaning of classroom spaces and shared equipment.
Meals: Maintain children in cohorts and utilize outside spaces when possible.
Hallways: Eliminate lockers or group them by student cohorts, create one-way travel directions, stagger class periods, and keep children in classrooms while rotating teachers.
Transportation: Reduce the number of children in each vehicle to maintain physical distancing and enforce face coverings.
Prekindergarten: Group students in cohorts, emphasize hand hygiene, maximize the use of outside spaces, and limit adult visitors. Allow interactive play.
Elementary: Require face coverings and physical distancing (3–6 feet apart), maintain student cohorts, and maximize use of outdoor spaces. Reducing classmate interactions on the playground is not strongly recommended.
Secondary: Require universal face coverings, physical distancing, and avoiding close contact for activities with high risk of increased exhalation (exercise, singing, shouting). Use block schedules to cohort students, and rotate teachers rather than students.
Special education: Make case-by-case decisions to meet children's special needs, which often require physical proximity to adults (e.g., paraprofessional aides, therapists).
Universal testing was not recommended as a way to make school-attendance decisions, although virologic testing may be needed for children with COVID-19 contacts or symptoms to return to school.
American Academy of Pediatrics.COVID-19 planning considerations: Guidance for school re-entry. 2020 Jun 25; [e-pub]. (https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/)
Comment
Schools provide much more to children than just educational instruction, and creating ways to bring children back, while keeping both students and staff safe, should be at the top of our priorities. Although the AAP guidelines aim to address all children, it seems clear that policies for returning to school will need to be flexible and modified in response to virus levels in individual communities. Reopening schools will require significant commitment of resources, but is there a more important investment we can make at this time?
If parents ask about the safety of returning to schools, clinicians can use a risk/benefit framework to help parents recognize the enormous benefits of returning to in-person instruction, including reduced parent stress; improved learning for children struggling with distance learning; and access to food, mental health supports, peers, and special education services that do not translate well through video. Anxious parents may want elimination of risk for COVID-19, but this is not possible, even with home schooling.