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Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the United States

Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the United States
Anita Cicero, Christina Potter, Tara Kirk Sell, Caitlin Rivers, Monica Schoch-Spana
Date posted:
May 15, 2020
Publication type:
The Johns Hopkins Center for Health Security
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Most elementary schools, middle schools, and high schools across the United States have been closed since March in an effort to reduce the spread of COVID-19. Schools that are able to do so have replaced classroom education with remote learning, using a range of tools and approaches. As of the publication of this report, governors from most US states have recommended or ordered that schools remain closed for the remainder of this academic year, affecting more than 50 million public school students. While a few schools may reopen before the end of the current school year, most schools, students, and their families in the United States are now facing uncertainty about whether or how schools will resume for in-class learning in the fall.

The White House issued guidelines for Opening Up America Again on April 16, 2020; many states have already finalized or are developing their own plans and taking steps toward reopening businesses, communities of faith, and other settings. Not all states that are now relaxing physical distancing restrictions have met the gating criteria set out in the White House guidelines, but they are motivated to reopen in order to blunt economic losses resulting from shut-down orders. School closures will have a direct impact on the ability to reopen the economy. Realistically, it will be difficult for many adults to return to work in person if their children are not back in school in the fall. Likewise, closures of summer camps, daycare centers, and after-school activities also affect the ability of many adults to return to work.

A host of guidance documents related to COVID-19 mitigation strategies for schools have recently been issued by various government and nongovernment organizations at the national and international levels. And a number of countries in Europe and Asia are now implementing a variety of approaches for returning K-12 schoolchildren to school. This report includes a summary and detailed Appendix on a selection of country approaches to school reopening. It is important to track these efforts and the implementation of the various guidances closely. Still, it will be difficult to tease out lessons learned absent rigorous study, since many adults will be returning to work, and physical distancing restrictions will be eased contemporaneously with schools reopening.

There is an urgent need to understand the evidence that would support how students could safely return to school. This is an extremely difficult decision, because of the uncertainties relating to risk. While published studies to date indicate that children with COVID-19 are less likely than adults to suffer severe illness, there is only limited scientific evidence, models, and anecdotal accounts attempting to gauge whether children with COVID-19 in school can efficiently transmit the virus to other children, teachers, school staff, and family members. Unanswered questions include: How vulnerable to severe illness are students who have underlying health conditions, such as asthma, diabetes, or severe obesity? How safe is it for adults who themselves have serious underlying health conditions to send their children back to school without fear of those children bringing the virus home and infecting others in the family? How safe is it for teachers, administrators, and other school staff, especially those who are medically vulnerable, to return to school and interact with students who may be asymptomatic but infectious? Are certain school communities at greater risk than others relative to exposure, and should each school community be evaluated independently to determine level of risk?

We need a national mandate to prioritize and quickly fund research to answer these scientific questions about children and COVID-19 so that governors, schools, teachers, and guardians can have greater certainty about the potential consequences related to reopening schools and can make informed decisions. While some studies are getting under way, the US government (as well as other national governments, nongovernment organizations, and philanthropies) should fund additional studies aimed at understanding the role of children in transmission of COVID-19. As schools reopen, models are not sufficient to determine the actual risk to school-aged children and the teachers and caregivers in their lives, given that available scientific evidence is not conclusive and continues to evolve.

Transmissibility studies, especially epidemiologic investigations using contact tracing and other data, are needed to understand COVID-19 transmission dynamics in school-aged children. We should also closely track the experience in countries where schools are starting to reopen during the pandemic and in those places in the United States that decide to open schools this spring or summer. For countries where schools have opened recently, formal case studies and cohort studies comparing whether transmission is occurring in families of students or in teachers or staff in those schools will be very important. Support for this critical research is now needed to fill in the blanks of our knowledge as much as possible as schools in the United States decide how and under what conditions they will open their doors during the 2020-21 school year. To help maintain momentum and focus, a national advisory group composed of pediatric, public health, and education researchers should be established to regularly review the state of the science and provide coherent updates on key questions, including recommendations supported by data.



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