As we wrestle in the next few weeks over which of the nation’s schools to reopen — and let’s be clear, not all of them will be safe to restart — we need to understand this: Kindergarten through the 12th grade involves more than just the classroom.
To create safe schools is much more complex than just having students wear face masks and sit physically distanced from one another in class. We must ensure that all five of the core school-based activities — transportation, time in the classroom, mealtimes, gym and extracurricular activities — are safe.
To do this, we created a school risk index to assess the dangers and offer recommendations to reduce the chance of spreading the virus, not only among students but also among teachers and other employees.
Safety First
Different school activities have different risk levels, offering options to reopen schools as safely as possible. In all reopenings, basic precautions are essential: low community spread, physical distancing, mask-wearing, hand hygiene, adequate ventilation and cleaning of facilities at night.
LOW RISK
MEDIUM RISK
HIGH RISK
Transportation
to and from school
Walk or ride a bicycle
Carpool with non-household members
School bus
Public transportation
(subway, bus)
Riding in a car
Household members only
Routine classwork
Desk-based instruction
Unmonitored study hall
Lockers/changing rooms between classes
Shop and
vocational/
technical class
Going to the restroom
Lunchtime
Assuming 6 feet of distancing at all times
Picking up prepackaged meals
Cafeteria lunch line
Indoor seating in the
cafeteria
Indoor eating
in the classroom
Outdoor eating
Arts & Humanities
Art indoor
Band and orchestra
Supervised clubs and organizations
Choir
Drama performances
Recess & Athletics
Outdoor
playgrounds
Indoor non- contact sports
All contact sports, indoor or outdoor
Outdoor
non-contact sports
Locker rooms
Transportation to and from school
LOW RISK
MEDIUM RISK
HIGH RISK
Walk or ride a bicycle
Carpool with non-household members
School bus
Public
transportation
Automobile
Household members only
(subway, bus)
Routine classwork
LOW RISK
MEDIUM RISK
HIGH RISK
Unmonitored study hall
Desk-based instruction
Lockers/
changing rooms between classes
Shop and
vocational/
technical class
Going to the restroom
Lunchtime
Assuming 6 feet of distancing at all times
LOW RISK
MEDIUM RISK
HIGH RISK
Cafeteria lunch line
Picking up prepackaged meals
Indoor seating in the cafeteria
Indoor eating
in the classroom
Outdoor eating
Arts & Humanities
LOW RISK
MEDIUM RISK
HIGH RISK
Band and orchestra
Art indoor
Supervised clubs and organizations
Choir
Drama performances
Recess & Athletics
LOW RISK
MEDIUM RISK
HIGH RISK
Indoor non- contact sports
Outdoor
playgrounds
All contact sports, indoor or outdoor
Outdoor
non-contact sports
Locker rooms
Four principles stand out.
First, schools cannot reopen safely when community transmission is high and climbing. In our view, schools should open only in places that have fewer than 75 confirmed cases per 100,000 people cumulatively over the previous seven days with a test positivity rate below 5 percent. By our count, 12 states and the District of Columbia meet both metrics. In many larger states, some counties or cities meet those criteria. Even with those numbers, about one in 1,300 people will return to school with confirmed cases of the coronavirus, meaning a school of 350 students, faculty and staff will have roughly a one-in-four chance of someone coming in with Covid-19. (Many countries, such as Japan, Austria and Italy, have suppressed the virus to the extent that they have fewer than one in 10,000 people with confirmed cases.)
Second, schools should avoid high-risk activities. This means no contact sports either in the gym or in competitive athletics for high school students. It also means no band, choir or drama performances. We know that this will be both disappointing and difficult. But close contact for prolonged periods of time with forced exhalations is what increases the risk of transmission. Playing football and basketball and wrestling simply cannot be done safely. We understand that missing a season could lead to missed scholarships for student athletes. But these activities will have to wait a year. That said, we should allow outside physical activity on playgrounds, ideally with masks, and noncontact sports like track and field.
For meals it means no cafeteria time, where crowding would be likely to encourage spread. The best alternative is to have meals packaged and delivered to classrooms, which would also reduce contact between cafeteria workers and students. Schools should also bar the use of lockers because they cause crowding and congestion and therefore increase the risk of transmission.
Third, focus on the basics where risks are tolerable — that is at the medium level or lower on our chart. Yes, the classroom may pose the most risk, as students will spend the most time there and are in proximity to others who may cough or sneeze. This will certainly be the case during cold and flu season. But we think that with proper funding, classrooms can be made relatively safe.
Which leads us to our fourth point. Schools must adhere to public health measures and reduce density in classrooms and elsewhere on campus.
Students, faculty and other employees should wear masks properly at all times. Face shields, while not as good as masks — droplets can enter or exit from the bottom or sides — are better than nothing and an option for those who for medical reasons are unable to wear a mask. Everyone should wash hands or sanitize them every hour or so. Adequate ventilation and rigorous nightly cleaning of facilities with disinfectants will also need to be aspects of these return-to-school strategies.
Schools need to reduce class size to allow students to be 6 feet apart. Recommendations from the National Academies of Sciences, Engineering and Medicine and data from other countries suggest some 10 to 15 students in a regular classroom is about right. Students should also be assigned to “pods” or “cohorts” — small groups to limit the number of people they interact with throughout the day. Students should not change classrooms — teachers should — and student arrivals and departures should be staggered.
How can we do this? One step is to use cafeterias, gyms, band rooms and other spaces as classrooms. Other options for instruction might be turning to playing fields, tents and mobile classrooms. Music and gym teachers and athletic coaches could assist in teaching outside their normal assignments.
Being safe is not free. Unless school safety becomes something exclusively for the rich, the federal government will have to provide the funds for school districts to carry out these measures. Schools will need to hire more staff, put up new classrooms and have available personal protective equipment — hand sanitizer, air filters and other safety gear.
Funding will also be needed to pay for off-campus or virtual options for students whose immune systems are compromised or are otherwise at risk. Teachers too, who are at risk, should not be forced to teach in person and should be assigned to virtual classrooms or after-school tutoring without being penalized for it.
We all want schools to open, even as we recognize the risks attached. Will the measures we outline permit a normal school experience? No. But these recommendations will permit relatively safe schools and allow in-person education and as much socializing as possible.
During this pandemic, that is the best we can hope for.
Ezekiel J. Emanuel (@ZekeEmanuel) is vice provost of global initiatives and professor of medical ethics and health policy at the University of Pennsylvania. Saskia Popescu (@SaskiaPopescu) is an infectious disease epidemiologist. James Phillips (@DrPhillipsMD) is chief of disaster medicine at George Washington University’s School of Medicine and Health Sciences.
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