Translating the latest evidence into clear recommendations, a multi-disciplinary group of experts delivers guidance on how schools and districts can reduce in-school Covid-19 risks for both children and adults to near zero. The key to opening schools safely? High quality infection control. 

During this year of the COVID-19 pandemic, the question of how to handle infection risks in schools has fueled heated debates and passionate pleas. Early on, in the absence of good evidence, schools quickly closed or moved to ad-hoc remote learning to keep students, staff and their communities safe -- yet in-person education’s essential role in our society soon became clear. Without in-person school, and combined with the lack of paid leave and limits on support for small businesses, many children struggle, and so do their parents. Educators and school staff, at higher risk than children and worried about their safety, were pitched against parents and politicians eager to re-open schools.

“The nation’s educators are living through extraordinary challenges. At the same time, recommendations to get students back for in-person learning are necessary for the good of students, and reasonable, because safety can be achieved,” says Danielle Allen, director of the Edmond J. Safra Center for Ethics at Harvard University. “We need to stop thinking about schools in a binary way -- open or closed -- and instead assess the risk for in-school transmission and the quality of infection control regimes in each school, each cohort, and each classroom and hallway.”   

New Guidance

New guidance from a multi-disciplinary group of experts at Harvard University, Brown University, Boston University, Tufts University, and New America led by Allen now provides a framework for schools and districts to focus on infection control, and to achieve building safety, even in the context of high community spread (the current reality in most communities across the U.S.). The report, “Schools and the Path to Zero: Strategies for Pandemic Resilience in the Face of High Community Spread” follows previous guidance on building pandemic resilient schools by the same group, published in July. The prior guidance had recommended using community spread metrics as a key factor in assessing mitigation measures and school openings or closures. Now, community spread metrics serve as important pieces of information, but the recommendation is that schools focus on rates of in-school transmission and metrics for the quality of infection control. 

“Early in the pandemic, we saw schools as high-risk congregate settings, because students and teachers spend a lot of time together in the same rooms and then go back into the community, and we didn’t know yet how exactly the virus spreads and who is most at risk”, says Ashish K. Jha, dean of the Brown University School of Public Health. “Then we learned more about the virus and how to stop infections. And where schools opened up again with mitigation measures in place, we saw no evidence that schools drive significant community spread. With the right controls in place, schools can even maintain lower infection rates than the community.”  

Keeping students and teachers safe

"We now have scientific evidence, including from school openings around the world, that shows that younger children are less likely to get infected and that school openings for this age group do not substantially contribute to community transmission”, says Helen Jenkins, Associate Professor of Biostatistics at Boston University. “Although school openings for older students may carry a higher risk of transmission, we now have proven tools at our disposal to reduce risks of transmission within schools effectively.” 

Based on data from the UK, teachers’ risk of severe COVID-19 is comparable to other working adults and less than high-risk occupations such as healthcare workers. “Like other working adults, infections among teachers are largely arising from community-level transmission as opposed to from places of work,” says Thomas Tsai, a surgeon at Brigham and Women’s Hospital and Assistant Professor at the Harvard T.H. Chan School of Public Health. “From the standpoint of severe COVID-19, where -- and whether -- you teach may matter less than where you live. Protecting our teachers and students is a priority, and we need to continue to ensure adequate infection control measures in schools to ensure safe conditions for in-person education.”

Evidence-based strategies

“We must prioritize keeping kids in school, and that means as levels of community spread rise it cannot be ‘schools as usual’. The strategies we are recommending for schools are evidence-based and, critically, designed to reduce risk for both students and adults,” says Joseph Allen, an Associate Professor and Director of the Healthy Buildings Program at Harvard T.H. Chan School of Public Health.

Key elements of the guidance document include:

• Although community spread metrics serve as important pieces of information, it is recommended that schools focus on rates of in-school transmission and metrics for the quality of infection control. 
• Infection control in schools has rarely been addressed and is the central focus of the new guidance.  
• Infection control in the context of widespread community spread requires a simultaneous focus on universal precautions, environmental controls, and changes to programs and practices.
• Strict implementation of practices of infection control requires healthy partnerships among school leaders, educators, and communities, as well as short and long-term public investment in the public education system’s infrastructure and workforce.
• To facilitate in-building safety for in-person learning, schools need to address six central topics when settling on their strategy: trust; transportation; infection control; occupational health and safety standards; testing; and vaccines. 

"For too many decades in this country we have treated educators as having competing interests to students and families, rather than recognizing them as essential partners in ensuring children's healthy academic, socioemotional, and physical development,” says Meira Levinson, a Professor of Education at Harvard’s Graduate School of Education. “I am excited that we have a scientifically-based roadmap for how schools can reopen, and stay open, in a way that keeps the risk of school-based COVID-19 transmission to children and adults at low or near-zero levels."