A kid sniffles on a school bus. A parent’s throat is sore. A teacher’s spouse feels sick.
As schools reopen in the fall, previously common and insignificant situations will carry new prospects of danger. To guide districts’ responses, the state Department of Elementary and Secondary Education this week released protocols for when students, staffers, or families experience symptoms or test positive for COVID-19 — a 19-page plan that makes clear how complicated and challenging the new school year will be.
“Even as we remain vigilant, and public health metrics in Massachusetts remain positive, the risk of exposure to COVID-19 in school will not be zero,” the guidance reads. “No single strategy can ever be perfect, but all strategies together will reduce risk.”
The guidance includes detailed instructions for various scenarios, which all stress the importance of assessing symptoms, isolating the sick, disinfecting spaces, testing, and staying home while awaiting test results and notifying the school. It says schools should promptly notify the families of any “close contacts” — anyone who came within 6 feet of the infected person in recent days for more than 10 minutes — so that family member can self-isolate and get tested too.
Several epidemiologists praised the document as thoughtful and thorough, though they also raised concerns about whether it sufficiently addresses asymptomatic spread of COVID. And they believe a resurgence of cases is likely in Massachusetts in the fall if not sooner, so the plans may become moot.
“The fall is expected to be really very difficult indeed,” said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health. “For all that I admire about this plan, and I am impressed by it, I am anxious that the pandemic is not going to play along and we have to account for that.”
The guidance warns that if Massachusetts’ public health metrics worsen, indicating a second surge of infections locally, the state will communicate with schools to determine whether in-person education should continue.
Epidemiologists cautioned that scientists still don’t have a good understanding of children’s role in transmitting COVID-19, though children aren’t prone to severe complications. Some evidence shows many children can transmit the infection at similar rates to adults, they said.
In case of children or staffers feeling sick with a fever, cough, sore throat, or other symptoms, they should stay home and seek a COVID test. If at school, they should go to the school nurse to be evaluated, the state guidance says.
If someone tests positive, their “close contacts” should be promptly notified, isolated, and tested, the guidance states. In elementary schools where students are in the same classrooms for long periods, everyone in the group should be tested or quarantined for two weeks. And wherever possible, students’ seats should be assigned during classes, buses, and meals, and those assignments documented to assist with contact tracing in case someone becomes infected.
When students must quarantine at home, their learning should continue remotely. People who test negative can return to class. Those who test positive must isolate for at least 10 days and not return until they have experienced three days without a fever and symptoms improving.
If a student or staffer has been around anyone else who tested positive, the student or staffer should also be tested or quarantined for two weeks.
Samuel Scarpino, an epidemiologist at Northeastern University, said the protocols seem to assume that test results will return quickly, but the current reality is far different. Test results are now often delayed by up to a week or more in Massachusetts. Scarpino envisioned dozens of kids in a school at one time having symptoms of the common cold, which are similar to those for COVID-19.
“A very likely scenario with this plan is that schools are going to be faced with a very tough decision as they’re waiting for test results to come back” about whether to close parts of the school, Scarpino said. “The current biggest issue we need to address for COVID is getting the test delay time to under 36 hours” to quickly detect outbreaks and prevent more infections.
The state has said its goal is to safely return as many students as possible to in-person learning. But it has also requested all districts prepare three reopening models: one fully in-person, one hybrid scenario that mixes remote and in-person, and one that is all remote.
The guidance envisions new disease-control roles for everyone involved in schools. For instance, bus drivers and teachers should be trained on recognizing symptoms. If a driver notices symptoms as a child boards, the driver should ask the parent or other caregiver, if present, to take the child home. Otherwise, the driver should ensure the child stays at least 3 feet from others, and that all the children keep their masks on during the ride, then alert the school so that a staffer can meet the child for a medical evaluation.
Children with symptoms should not return home on buses. They should wait in the school’s designated medical waiting room until their caregiver can pick them up.
If schools see multiple cases, they should work with local health boards to determine whether transmission is likely happening at the school. If that is suspected, local and state health and education officials will work together to decide next steps, which may include closing the school fully or partially for a period from a few days to a few weeks.
If multiple schools in a district see outbreaks, entire districts may need to close, the state guidance says. And if cities or towns experience significant waves of infections, individual schools may need to shut down.
Several epidemiologists said the guidance doesn’t adequately address the fact that many children who become infected don’t experience symptoms but are still contagious. They said widespread testing within schools — as some colleges have announced plans to do — would likely be needed to sufficiently detect those silent cases, but that’s an expensive proposition. Instead, the document suggests students and school personnel seek testing at a public site that may require an appointment or doctor’s referral.
“I wish that testing was more directly incorporated into the schools’ systems such that students/staff/ faculty could receive tests at the school itself,” Nadia Abuelezam, an epidemiologist at Boston College, said in an e-mail. “I understand that comes with a cost and may be reproducing services with the healthcare system, but it also will likely cause delays in testing, results, and children/staff/teachers’ return to school.”
Under the guidance, families are responsible for screening kids, and staff must monitor themselves daily for symptoms.
Parents — many of whom are nervous about sending their children back to class — would love to see schools take responsibility for daily symptom screening and testing everyone before reopening, said Tiffani Jackson, a parent organizer with the Boston Education Justice Alliance.
“The school system has to take the initiative to make sure all kids and adults in their building are safe,” Jackson said, but she acknowledged that cash-strapped schools in Boston likely wouldn’t be able to afford such efforts.
Jonathan Haines, a school nurse at BPS’ McKinley Middle School, said the plan seemed doable in wealthier suburban districts where families have better access to health care and schools have more resources, but unrealistic in Boston. For example, he questioned who would be responsible for tracking all the students isolating at home awaiting test results.
“It’s very difficult to implement the guidelines to fidelity — almost impossible, I would say — not because the guidelines are wrong, but because of the staffing conditions in the schools,” Haines said. “We’re not hospitals.”
Naomi Martin can be reached at firstname.lastname@example.org.