Masks, Distancing, Hand-washing Crucial for Reopening Schools

Part of the The Briefing: The Impact of COVID-19 Series
Masks, Distancing, Hand-washing Crucial for Reopening Schools
Professors Kristen Stephens, Dr. Ibukun Christine Akinboyo and Dr. Kanecia Obie Zimmerman

State leaders and education officials weighing whether to re-open schools are considering myriad factors, from infection rates to vaccine rollout to a reluctance on the part of both teachers and families.

Three Duke experts, including a pediatrics professor co-leading a National Institutes of Health-funded study on how to reopen schools safely, spoke to journalists Wednesday in a virtual media briefing. (Watch the briefing on YouTube)

Here are excerpts:

DR. IBUKUN CHRISTINE AKINBOYO, ASSISTANT PROFESSOR OF PEDIATRICS

On whether schools need COVID-19 surveillance testing to reopen safely

“It depends. Testing has been essential in the overnight setting, on college campuses. You’re bringing in a number of people across the country, young adults, who are now coming into a dormitory-style setting. In that context, it’s important (to have testing).”

“The opposite is the case in K-12. For the most part, a lot of schools are based in a district or city level and are just a reflection of local communities. You have people coming in daily and going back into the local community.”

On whether rapid antigen tests work

“The rapid antigen test has some limitations. It could be useful in picking up some infections … in symptomatic children. When we have asymptomatic groups, the test may have a lower sensitivity in that population. We just have to be careful about what the test is, what the technology is behind the test … there are ways to ensure the right test is used in the right population. If it’s the rapid test, or rapid pathogen test, it may need a confirmatory piece.”

“A rapid test may be useful. It depends on the type of test, and specifically, what’s the population you’re testing. Are you testing a symptomatic child or an asymptomatic child?”

On how a family’s personal experience influences an in-school decision

“People’s experiences over the last year may have differed significantly and that would impact their decision to choose in-person education or not. Some have thrived; some may not have thrived. Also, knowing and seeing people infected, hospitalized and dying from this disease may be different from seeing case numbers and numbers on TV or being somewhat removed from the overwhelming COVID information that has spread. That will impact how people will come back to school. It will impact how people will interpret school guidance.”

On importance of teachers being vaccinated 

“It’s certainly important to include vaccinations as a part of the mitigation strategies to reduce the case burden in our communities and further reduce in-school transmission. We know education is already happening. The question is, can we come back in person in some settings?”

“We know that even prior to having the vaccines, we were able to see and experience in-person education safely. It would be a huge advantage to ensure that a larger proportion of those returning in person are vaccinated.”

On the importance of communicating data and facts

“Transparency works. There are some people that, no matter what you do, you can’t get through to them. But for the most part, people are looking for honest and consistent data or information about what’s happening in schools. And building back trust, if that wasn’t happening before, or solidifying trust.”

“Be as transparent as you can be around infections, around cases, when they happen, where the clusters are, who is impacted.”

DR. KANECIA OBIE ZIMMERMAN, ASSOCIATE PROFESSOR OF PEDIATRICS

On why data show low COVID transmission at in-person schools

“We know the mitigation strategies work. They work outside of school buildings. The CDC has recommended ... that we wash our hands, we (distance), we wear a mask. We know those things are successful. There is no fundamental reason to believe that wouldn’t work inside a school building as well.”

“We know schools are really good at enforcing rules, and that really is the difference. (Schools) are working really hard to make sure people are actually enforcing the mitigation measures.”

On rapid antigen tests at schools

“If schools are going to implement testing, it’s important to remember these tests aren’t perfect. Really adhering to the mitigation strategies is still going to be very, very important. Just because we have testing does not give us a free pass … to relax what we’re doing, to not mask, to not distance, to not be very vigilant.”

“That’s a potential risk, to have some false security in the surveillance testing.”

On school reopening in under-resourced communities

“We know, unfortunately, that communities of color have been disproportionately impacted by COVID-19. That’s largely related to the fact that many communities of color have family members, parents, etc. that are on the front lines, and on the front lines potentially without appropriate PPE.”

“So when we’re thinking about the idea of schools, just because someone comes into the building, even if they came from a community that might have been more disproportionately impacted by COVID-19, does not translate into a higher risk, potentially, of spreading disease.”

“Fortunately, COVID-19 knows no color. Fortunately, the mitigation strategies know no color. They have no idea who you are, what community you came from or anything else. The assumption with mitigation strategies is that everyone is infected. So we should apply the same standard, the same mitigation strategies, the same help, everything, to everyone. We get into trouble when we start parsing things out and trying to decide who’s infected, who’s not. We should assume everyone is infected.”

On if there’s an acceptable level of risk at in-person school

“People are getting infected anyway. Schools open, schools closed, regardless, unfortunately people are getting infected.”

“It’s not whether or not kids are going to get infected, people are going to get infected. Can we put them in an environment where there are guidance and rules in place to help prevent transmission at really high rates? I don’t think schools necessarily need to shut down if there’s one case that comes into the building or a couple of cases. We know there will be cases coming into the building. That’s why the mitigation strategies are in place. We’re treating everyone as if they’re infected.”

On the need for schools to have equal funding and resources to re-open

“It’s absolutely key. We have a long way to go. We know for many years schools have been underfunded across the board and in some cases particularly in communities of color. Thinking about how to do that is very important.”

“But fortunately, some of the things, like masking, handwashing, don’t cost an exorbitant amount of money. Certainly, things like space are going to be important. There are some schools that don’t have running water or warm water, so those are things that need to be addressed. But we’re not talking about entire overhauls in order to allow people to go to school safely.”

On determining if infections connect back to school interactions

“Evaluating community spread versus secondary transmission is an exercise in epidemiology. You’re evaluating who your close contacts are. This contact tracing piece is actually very, very important to determine whether or not this came from the community versus whether it came from within the school, or it came from a party, or whatever. That’s really the piece to identify whether or not things are coming from the community or within school.”

“We do contract tracing as a general rule. In schools you have the potential to be even more robust (in contact tracing). You know who people have been around. You have a register of all the kids who came to school, all the adults who were in school that day. So you have the ability to understand that.”

KRISTEN R. STEPHENS, ASSOCIATE PROFESSOR OF THE PRACTICE OF EDUCATION

On teachers’ view of returning to in-person teaching

“Of the teachers I have the opportunity to interact with weekly, they’re all very eager to return to school. They prefer to see their students in person. They miss seeing them and they know the classroom in the traditional sense is the best place for students to be. In terms of concerns, they primarily have to do with instructional concerns rather than mitigation concerns.”

“We kind of have approached this problem from a binary – either they’re in school or attending class virtually. But what’s going on now, across North Carolina as well as in many other states, there’s kind of a mixture going on and the models vary dramatically. So the concern is, what does instruction look like? How do I need to plan based on the model my particular school or district is using?”

On impact of children being out of school

“We all know that being in school in the traditional sense is the best for all students. School is not only a place where children receive instruction, there are a lot of other services children receive in school. Teachers I know are concerned about not having that day-to-day physical contact with their students so they can monitor and see how they’re doing not only academically but social/emotionally and health-wise.”

“In terms of the mitigation piece, there still is concern around mitigation in regards to the simple infrastructure of our schools. And they vary drastically. If you’ve driven by any elementary or middle school today, you’ll often see the mobile classrooms. That’s due in parge part because we have overcrowding in our schools.”

“It does become difficult, when you have overcrowded classrooms, to retain that six-foot proximity from each other. If all students are going to return to school, we have to have some strategies in place. Do we even have the infrastructure to have that distance between students and staff to be maintained?”

On importance of vaccinating teachers

“I think teachers would like the added protection of being vaccinated. I think we’d all like that. But I don’t think the majority of them are saying, ‘I’m not going to return to the classroom until I’m vaccinated.’ They’re in teaching not for the pay, but because they’re really devoted to their students. They really want to be with their students in the classroom and want what’s best for their students. They’re always looking through that lens.”

On whether schools should start the next school year with remediation

“Certainly, we’ll want to determine as best we can how much, if any, learning loss has occurred. I would not want to see a sole focus on remediation. What typically happens when you see that is the drill and kill and children are uninspired. I’d like to see us get kids really excited about being together and learning together. We can’t just focus on remediation without also focusing on enrichment experiences.”

“I would say we really need to tap into student interest. I hear a lot from teachers these days who are having a lot of problems engaging students in virtual learning, and even as they return to school, engaging them in learning again. I don’t think if we approach it from a remediation (strategy) … we’re going to inspire students to want to join us on the learning journey. We’ve got to temper that a bit with making learning enjoyable and fun again, to bring them aboard.”

On making learning engaging when they go back to school

“The students are really taking responsibility for this, which is really good to see. They may need reminders here and there. But one thing that’s going to be really important as we move forward is transparent communication from school to home. Parents also play an important role as well in terms of speaking with their children about maintaining those mitigation strategies while they’re at school.”

“What happens if there is a case in a school? Should the whole school shut down? Really keeping students in little insular pods will make it more feasible, if there is an outbreak, of really pinpointing where that outbreak is so maybe the whole school doesn’t have to shut down.”

“Structurally, there’s a lot of things that need to happen.”

“There isn’t hot water in many or our schools, nor is there soap and paper towels in many of our schools. So having the resources will make everyone – parents and teachers - more comfortable about coming back to school.”

Faculty Participants

Dr. Ibukun Christine Akinboyo
Dr. Ibukun Akinboyo is an assistant professor of pediatrics in the Division of Pediatric Infectious Diseases at the Duke School of Medicine and a medical director of pediatric infection prevention at Duke University Medical Center.

Kristen R. Stephens
Kristen Stephens is an associate professor of the practice of education. She is co-director of the working group on education policy for the Samuel DuBois Cook Center on Social Equity and president of the American Association for Gifted Children.

Dr. Kanecia Obie Zimmerman
Dr. Kanecia Zimmerman is an associate professor of pediatrics in the Division of Critical Care Medicine at Duke University Medical Center. She is co-leading a pilot project funded by the National Institutes of Health studying the safe reopening of schools. Zimmerman co-authored research in Pediatrics that supports reopening.

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Duke experts on a variety of other topics related the coronavirus pandemic can be found here.